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.
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.
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
Experience in discharge planning and/or chart review
1+ years of UM/UR experience required including experience performing admission and continued inpatient stay reviews
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)
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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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