Inpatient Care Management Nurse RN - Remote

UnitedHealth Group; Alabama; Remote; USD 60,000 - 107,000; Full time

Job summary

UnitedHealth Group in Mobile, AL is seeking an Inpatient Care Management Nurse to ensure proper utilization of health services by assessing member needs and identifying care solutions that keep patients healthy.

You will perform initial and concurrent reviews using InterQual criteria, collaborate with facility staff and Medical Directors, and support timely discharge planning while upholding SOPs and quality standards. Residence in Eastern or Central Time is 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 Utilization Review experience using InterQual Guidelines, in hospital or health insurance.
• Designated workspace and access to secure high-speed internet at home.
• Permanent residence in Eastern or Central Time Zone.

Responsibilities

• Perform initial and concurrent review of inpatient cases applying InterQual criteria.
• Discuss cases with facility healthcare professionals to obtain plans-of-care.
• Collaborate with Medical Directors on utilization management.
• Support progression of care to appropriate levels and discharge planning.

Skills

Inpatient nursing

Utilization Review

Clinical collaboration

Education

RN license

Tools

InterQual Guidelines

Job description

About This Role

As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of health services by assessing and interpreting member needs and identifying solutions to help members live healthier lives. This role is ideal for those looking to make an impact in a supportive and innovative environment.

Highlights

• Pay: $60,200 - $107,400/year
• Location: Mobile, AL
• Brand/Division: Optum
• Schedule: Full Time, Day shift
• Residency: Must reside in Eastern or Central Time Zones

What You'll Do

• 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
• Participate 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 cases 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

Requirements

• Education:
  • Active, unrestricted RN license in state of residence
• Experience:
  • 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
• Licenses & Certifications:
  • Active RN license required
  • 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

About UnitedHealth Group

UnitedHealth Group is a leading healthcare provider committed to delivering exceptional patient care. They focus on improving health outcomes through innovative solutions and a collaborative team culture. Their mission is to help people live healthier lives and make the health system work better for everyone.