Inpatient Care Management Nurse RN - Telecommute In FL

Unitedhealth Group Inc. Tampa , FL 33602

Posted 2 months ago

As a Utilization Management Nurse (RN), 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. Ready for a new path? Join us and start doing your life's best work.(sm)

The hours for this position are Monday through Friday, 8 am to 5 pm Eastern Time.

If you live in the state of Florida, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Perform initial and concurrent review of inpatient cases applying InterQual for approval and sending to Medical Directors if review is necessary for determining an adverse determination

  • Discuss cases with facility healthcare professionals to obtain care plans

  • Collaborate with UnitedHealthcare Medical Directors to perform 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 sister segments

  • 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

  • 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 telephonic and in-person staff meetings

  • Build and maintain relationships

  • Gather clinical information to assess and expedite care needs

  • Maintain appropriate and accurate documentation

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:

  • Current, unrestricted RN license

  • 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

  • Demonstrate a 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

  • Resident of the state of Florida

Preferred Qualifications:

  • Bachelor's degree

  • Experience in discharge planning and/or chart review

  • 1+ years of UM/UR experience required including experience performing admission and continued inpatient stay reviews

  • Compact license

  • Familiarity with InterQual criteria guidelines

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

  • All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

For more information on our Internal Job Posting Policy, click here.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Job Keywords: Registered Nurse, RN, RN Case Manager, Utilization Manager, Utilization Review RN, Concurrent Review RN, Telecommute, Telecommuting, Work From Home, UM Nurse, CCR RN, Managed Care, case management, Telecommute, UHC, UnitedHealthcare, Tampa, FL, Florida

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Inpatient Care Management Nurse RN - Telecommute In FL

Unitedhealth Group Inc.