Job Description

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. 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.

If you are located in the Central time zone, you will have the flexibility to telecommute* as you take on some tough challenges.

Work schedule will be 8a - 5pm Monday to Friday, central time zone.

Primary Responsibilities:

* Perform initial and concurrent review of inpatient cases applying MCG criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination.
* Discuss cases with facility healthcare professionals to obtain plans-of-care
* Collaborate with UnitedHealthcare 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 sister segments.
* 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 telephonic and in-person staff meetings
* Plan for MCG Certification
* 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:

* A current, unrestricted MO state RN license is required
* Minimum of 3 years total RN experience including recent clinical experience in an inpatient/acute setting
* 1 year or more of UM/UR experience required including experience performing admission and continued inpatient stay reviews using either Interqual or MCG criteria.
* MCG Certification or willing to obtain within one year of service
* Demonstrate a proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
* Must have a designated work space and access to install secure high speed internet via cable/DSL in home
* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employee must comply with any state and local masking orders

Preferred Qualifications:

* Experience in discharge planning and/or chart review
* MCG Certification
* Compact license
* Experience with utilization review for an insurance company or in a managed care environment
* Familiarity with Milliman criteria guidelines
* Bachelor's degree

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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)

*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, telecommute, telecommuting, telecommuter, remote, Saint Louis, MO