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.

Work schedule will be Monday to Friday 8 AM to 5 PM in MST time zone.

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

Primary Responsibilities:

* Perform utilization and concurrent review of inpatient cases using MCG 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 using the clinical platform
* Consult with the Medical Director as needed to troubleshoot difficult or complex cases
* Identify opportunities for improved communication or processes
* Participate in telephonic staff meetings
* Some positions may require specific State residency and/or RN licensure

It feels great to have autonomy, and there's also a lot of responsibility that comes with it. In this role, you'll be accountable for making decisions that directly impact our members. And at the same time, you'll be challenged by leveraging technologies and resources in a rapidly-changing, production-driven environment.

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 compact RN license
* 3+ years total RN experience including hands on clinical experience in an inpatient acute setting in ICU / CCU / ER / Medical-Surgical
* 1+ years of Utilization Review experience in Managed Care or in an Acute Hospital setting
* Must demonstrate a proficiency in computer skills - Windows, IM, Excel (Microsoft suite), Outlook, clinical platforms
* 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)
* Must be living in a location that can receive high-speed internet service with a minimum speed of 5 download mps & 1 upload mps. (Mobile cellular data, e.g., fixed wireless, air cards / MiFi devices, and satellite are not approved means of internet connectivity and do not meet the criteria for high-speed internet connection through an Internet Service Provider.)
* 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:

* Bachelor's degree
* Experience in the use of MCG or Interqual criteria
* 2+ years of case management experience
* MCG or Case management certification
* Experience in discharge planning and / or clinical chart review
* Experience in acute long term care, acute rehabilitation, or skilled nursing facilities

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

Colorado Residents Only: The salary range for Colorado residents is $53,00 to $95,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives

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