Utilization Mgmt Nurse RN - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

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 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. 

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.

Work Schedule: Monday - Friday 
8am - 5pm (Flex Hours)

Primary Responsibilities:

• Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (i.e. MCG/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 

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 in State of Residence
• 3 years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/AIR/LTAC, Emergency Department, Urgent Care)
• Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities 
• 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
• Compact license
• 1 years of experience involving utilization review and evidence-based guidelines (i.e. MCG, InterQual Guidelines)
• Managed Care experience
• Experience performing discharge planning
• Ability to work independently
• Demonstrated effective verbal and written communication skills

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, Washington or New York City Residents Only: The salary range for California, Colorado, Connecticut, Nevada, Washington or New York City residents is $56,300 to $110,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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

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.