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)
Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You’ll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact?
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 a Utilization Management Nurse (RN), 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.
The hours for this position are Monday through Friday, 8 am to 5 pm Central Time.
If you are located in the CST Time Zone, you will have the flexibility to telecommute* as you take on some tough challenges.
- Perform initial and concurrent reviews of inpatient cases, InterQual criteria or approval, and send to Medical Directors for additional review when necessary
- Discuss cases with facility healthcare professionals to obtain care plans
- Collaborate with UnitedHealthcare Medical Directors to perform utilization management
- Participate 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 cases 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 InterQual 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.
- Current, unrestricted RN license in your state of residence
- InterQual Certification OR the ability to obtain certification within one year of service
- 3+ years of experience as an RN, including recent clinical experience in an inpatient / acute setting
- 1+ years of UM / UR experience, including performing admission and continued inpatient stay reviews using InterQual
- Proficient computer skills including Windows, instant message (IM), Microsoft Office (Excel, Outlook, etc.), and clinical platforms
- Designated workspace / home office and the ability to install secure high-speed internet via cable, DSL, fiber at home
- Able to work 8:00 to 5:00 CST hours
- Bachelor’s degree
- Compact license
- InterQual Certification
- Familiarity with InterQual criteria guidelines
- Experience in discharge planning and/or chart review
- Experience with utilization review for an insurance company or in a managed care environment
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: Inpatient Care Management Nurse RN, Inpatient, Acute, UM, UR, InterQual, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote, WAH, Richardson, TX, Texas