Inpatient Care Management Nurse RN - Remote

As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization.

You'll enjoy the flexibility to work remotely as you take on some tough challenges. The candidate can live anywhere in the Eastern or Central Time Zones. This position offers remote work flexibility* and the opportunity to tackle complex and rewarding challenges. Standard working hours are 8:00 a.m. to 5:00 p.m. based on your local time zone (EST or CST). Please note that the role requires a consistent schedule of Sunday through Thursday or Tuesday through Saturday following completion of training.

Primary Responsibilities

• Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria)
• Discuss cases with facility healthcare professionals to obtain plans-of-care
• Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management
• Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
• Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners
• Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
• Identify delays in care or services and manage with MD
• Follow all Standard Operating Procedures in end-to-end management of cases
• Obtain clinical information to assess and expedite alternate levels of care
• Facilitate timely and appropriate care and effective discharge planning
• Participate in team meetings, education, discussions, and related activities
• Maintain compliance with Federal, State and accreditation organizations
• Identify opportunities for improved communication or processes
• Participate in audit activities and meetings

Required Qualifications

• Active, unrestricted RN license in state of residence
• 1+ years recent clinical nursing experience in an Acute Inpatient Hospital setting
• 1+ years of experience in Utilization Review utilizing InterQual Guidelines, either within an Acute Inpatient Hospital setting or within a health insurance company
• Proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
• Designated workspace and access to install secure high-speed internet via cable / DSL in home
• Permanent residence in Eastern Standard Time or Central Standard Time

Preferred Qualifications

• Bachelor's degree
• Compact RN license
• 2+ years acute inpatient case management experience/utilization review
• Managed care experience

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.