Remote Inpatient Care Manager RN – Care Optimization

Texas Health Institute; Mobile (AL); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is hiring an Inpatient Care Management Nurse to ensure proper utilization of health services. You will assess member needs, plan care, and work with diverse teams to coordinate discharge planning.

The role offers remote work within CST/EST time zones and requires weekend coverage as needed. Requirements include an active RN license, 1+ year inpatient nursing, and utilization review experience with InterQual guidelines.

Qualifications

• Active, unrestricted RN license in state of residence.
• 1+ years of clinical nursing experience in an Acute Inpatient Hospital setting.
• 1+ years of experience in Utilization Review utilizing InterQual Guidelines.

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 Medical Directors on performing utilization management.
• Participate in discussions with Clinical Services to improve progression of care to the most appropriate level.
• Consult with Medical Director for complex cases and referrals to downstream partners.
• Apply clinical expertise when discussing cases with internal/external Case Managers and Physicians.
• Identify delays in care or services and manage with MD.
• Follow SOPs in end-to-end management of cases.
• Obtain clinical information to assess and expedite alternate levels of care.
• Facilitate timely and appropriate care and 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.

Skills

Computer skills

Clinical nursing skills

Utilization Review

InterQual knowledge

Education

Bachelor's degree

Compact RN license

Tools

Windows

Excel

Outlook

Clinical platforms

Job description

UnitedHealth Group is hiring an Inpatient Care Management Nurse to ensure proper utilization of health services. You will assess member needs, plan care, and work with diverse teams to coordinate discharge planning.

The role offers remote work within CST/EST time zones and requires weekend coverage as needed. Requirements include an active RN license, 1+ year inpatient nursing, and utilization review experience with InterQual guidelines.