Utilization Management Nurse RN – Remote

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

 

There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you’ll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As an Inpatient Care Manager 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. Ready for a new path? 

 

What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you’ll open doors for yourself that simply do not exist in any other organization, anywhere.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

• Perform utilization and concurrent review of inpatient cases using InterQual criteria
• Conduct clinical chart assessments
• Build and maintain relationships
• Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care
• Participate in rounds with the Medical Director and discussing cases as needed
• Determine need, if any, for intervention and discussing with Case Managers and physicians
• Identify and evaluate delays in care
• Initiate a discharge planning and readmission prevention plan
• Approve bed days for inpatient cases (when applicable)
• Arrange alternative care services; contact and maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum
• Gather clinical information to assess and expedite care needs
• Facilitate timely and appropriate care and effective discharge planning
• Participate in team meetings, education discussions, and related activities
• Maintain appropriate documentation
• Consult with the Medical Director as needed to troubleshoot difficult or complex cases
• Identify opportunities for improved communication or processes
• Participate in telephonic and in-person staff meetings

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current, unrestricted RN license
• 3+ years total RN experience including clinical experience in an inpatient/acute setting
• Demonstrate a 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

 

Preferred Qualifications:

• Bachelor’s degree
• 2+ years of Utilization and/or care management experience
• Experience in discharge planning and/or chart review
• Experience with utilization review for an insurance company or in a managed care environment
• Familiarity with InterQual criteria guidelines
   

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

 

California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C.  Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

 

 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.