There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As an Inpatient Care Manager 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)
What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
As an Onsite Inpatient Care Manager your duties will include:
Represent UHC working onsite at a multiple Skilled Nursing facilities in Douglas County, NE area.
Perform utilization and concurrent review of inpatient cases using Milliman criteria
Conduct clinical chart assessments
Build and maintain relationships
Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care
Participate in rounds with the Medical Director and discussing cases as needed
Determine need, if any, for intervention and discussing with Case Managers and physicians
Identify and evaluate delays in care
Initiate a discharge planning and readmission prevention plan
Approve bed days for inpatient cases (when applicable)
Arrange alternative care services; contact and maintain communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum
Gather clinical information to assess and expedite care needs
Facilitate timely and appropriate care and effective discharge planning
Participate in team meetings, education discussions, and related activities
Maintain appropriate documentation
Consult with the Medical Director as needed to troubleshoot difficult or complex cases
Identify opportunities for improved communication or processes
Participate in telephonic and in-person staff meetings
A current, unrestricted RN license in Nebraska is required
Demonstrate a proficiency in computer skills windows, IM, excel (Microsoft suite), Outlook, clinical platforms
Must be willing and able to commute to multiple Skilled Nursing facilities in Douglas County, NE area. (relocation assistance is not available for this position)
Minimum of 3 years total RN experience including experience in acute long term care, acute rehabilitation, and/or skilled nursing facilities
Must have a work space in their home that is separated from non-workspace areas and that can be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI)
Complete and maintain MCG Care Guideline Specialist Certification (coursework and passing grade) within one year of hire. Expenses are reimbursable upon successful completion
1 year or more of UM/UR experience including experience performing admission and continued inpatient stay reviews using either Interqual or MCG criteria
2 or more years of case management experience
Case management certification and/or experience
Experience in acute long term care, acute rehabilitation, or skilled nursing facilities
Experience in discharge planning and/or chart review
Experience with utilization review for an insurance company or in a managed care environment
Familiarity with Milliman criteria guidelines
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)
Diversity creates a healthier atmosphere: 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, UM Nurse, CCR RN, Managed Care, case management, UHC, Unitedhealthcare; acute long term care, acute rehabilitation, skilled nursing facilities
Unitedhealth Group Inc.