Utilization Management RN – Telecommute in CST

UnitedHealth Group
Published
November 18, 2021
Location
Houston, TX
Category
Job Type

Description

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

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 Management Nurse, 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. 

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.

Work schedule will be Monday - Friday from 8am - 5pm (Local Time)

If you are located within CST, will have the flexibility to telecommute* as you take on some tough challenges. 

Primary Responsibilities:

  • Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (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

 
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
  • 2+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF / AIR / LTAC, Emergency Department, Urgent Care, Doctor’s Office, School Nurse)
  • 1+ years of experience involving utilization review and evidence-based guidelines (MCG, InterQual Guidelines)
  • 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

Preferred Qualifications:

  • Bachelor’s degree
  • 2+ years case management experience
  • Managed Care experience
  • Experience performing discharge planning
  • Certification in Case Management
  • Compact license
  • Ability to work independently
  • Demonstrated effective verbal and written communication skills
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance
     

 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.

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: Utilization Review, Utilization Management, Concurrent Review, MCG, Milliman, InterQual, UM, UR, RN, Registered Nurse, Inpatient, Discharge Planning, Critical Care, Acute, Long Term Care, Acute Rehab, Telecommute, Telecommuter, Telecommuting, Work At Home, CT, CST, Houston, TX, Texas

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