Job 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. 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 8am-5pm Monday to Friday Eastern time zone.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

* Perform initial and concurrent review of inpatient cases applying MCG and Interqual 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 RN license is required
* 3+ years total RN experience including recent clinical experience in an inpatient/acute setting
* 1+ years 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 similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

* MCG Certification
* Compact license
* Bachelor's degree
* 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 Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)

Colorado Residents Only: The salary range for Colorado residents is $53,300 to $95,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*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, New York, NY, New Jersey, NJ, Texas, TX, Tennessee, TN, Ohio, OH, Hawaii, HI, Arizona, AZ