Remote Inpatient Care Manager RN - Utilization Review

UnitedHealth Group; Mobile (AL); À distance; USD 60 000 - 107 000; Plein temps

Résumé du poste

UnitedHealth Group seeks an Inpatient Care Management Nurse to ensure proper utilization of health services. You will assess member needs, identify solutions, and collaborate with facility staff to support appropriate levels of care. This role offers remote work flexibility with standard hours of 8:00 a.m.

to 5:00 p.m. in local time and a Sunday-Thursday or Tuesday-Saturday schedule after training. You’ll work with the Clinical Services team, Medical Directors, and Case Managers to review cases,

Qualifications

• Active, unrestricted RN license in state of residence.
• 1+ years recent clinical nursing in an Acute Inpatient Hospital setting.
• 1+ years Utilization Review using InterQual Guidelines.
• Proficiency in Windows, Excel, Outlook and clinical platforms.
• Designated workspace and access to secure high-speed internet at home.
• Permanent residence in Eastern or Central Time zones.

Responsabilités

• 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.
• Participate in discussions to improve progression of care to appropriate level.
• Consult with Medical Director for complex cases and referrals.
• Apply clinical expertise when discussing cases with Case Managers and Physicians.
• Identify delays in care and manage with MD.
• Follow SOPs in end-to-end management of cases.
• Facilitate timely and appropriate care and discharge planning.
• Participate in meetings, education, and related activities.
• Maintain compliance with Federal, State and accreditation standards.

Connaissances

RN license

Inpatient nursing

Utilization Review

InterQual

Microsoft Office

Home office setup

Eastern/Central Time availability

Formation

Bachelor's degree

Compact RN license

Description du poste

UnitedHealth Group seeks an Inpatient Care Management Nurse to ensure proper utilization of health services. You will assess member needs, identify solutions, and collaborate with facility staff to support appropriate levels of care. This role offers remote work flexibility with standard hours of 8:00 a.m.

to 5:00 p.m. in local time and a Sunday-Thursday or Tuesday-Saturday schedule after training. You’ll work with the Clinical Services team, Medical Directors, and Case Managers to review cases,