Remote Inpatient Care Manager RN – Utilization

University of Minnesota School of Nursing; Phoenix, Northern (AZ, KY); Hybrid; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits

Incentives program

401k plan

Job summary

UnitedHealth Group is seeking an Inpatient Care Management Nurse to join our remote-first team. You will assess patient needs, apply evidence-based criteria, and coordinate care across facilities, discharge planning, and downstream partners.

Qualifications include an active RN license, 3+ years of clinical nursing, and proficiency in Windows, Excel, and Outlook. A Bachelor's degree and managed care experience are preferred; strong communication and independent work skills are essential.

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, Doctor's Office, School Nurse).
• 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.

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

Skills

RN clinical knowledge

Effective communication

Independent worker

Microsoft Office

Critical thinking

Education

Bachelor's degree

Compact license

Managed Care experience

Discharge planning

Tools

Microsoft Excel

MS Outlook

EMR systems

Windows OS

Job description

UnitedHealth Group is seeking an Inpatient Care Management Nurse to join our remote-first team. You will assess patient needs, apply evidence-based criteria, and coordinate care across facilities, discharge planning, and downstream partners.

Qualifications include an active RN license, 3+ years of clinical nursing, and proficiency in Windows, Excel, and Outlook. A Bachelor's degree and managed care experience are preferred; strong communication and independent work skills are essential.