Inpatient Care Utilization Management Nurse EST CST

Davita Inc.; Atlanta (GA); Remote; USD 59,000 - 117,000; Full time

Job summary

A leading health organization seeks an Inpatient Care Management Nurse to enhance health outcomes through effective case management. This role requires an active RN license and involves collaborating with healthcare professionals to assess patient needs and ensure care quality. You'll enjoy flexible remote work options while contributing to meaningful health improvements.

Benefits

Comprehensive benefits package

Incentive and recognition programs

401k contribution

Qualifications

• Active, current, unrestricted RN license in the state of residence.
• 3+ years of acute care clinical nursing experience required.
• 1+ years of utilization review experience using evidence-based guidelines.

Responsibilities

• Ensure proper utilization of health services, assessing and interpreting member needs.
• Perform initial and concurrent review of inpatient cases applying evidence-based criteria.
• Facilitate timely and effective discharge planning.

Skills

Clinical nursing

Utilization review

Computer skills

Education

Active RN license

Bachelor's degree/BSN

Tools

Microsoft Suite

Job description

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start 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 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 hours will be Monday to Friday 8:00 AM - 5:00 PM in business time zone.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. HIGHLY prefer you be located in the Eastern or Central time zone.

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


• 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:

• Active, current, unrestricted RN license in the state of residence


• 3+ years of acute care clinical nursing experience


• 1+ years of utilization review experience using evidence-based guidelines


• Demonstrate a proficiency in computer skills - Windows, Teams, 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/ BSN


• Compact license


• Managed Care experience


• Experience performing discharge planning

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

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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