Remote Inpatient Care Management Nurse RN, NY

UnitedHealthcare

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Requisition Number: 2188140
Job Category: Nursing
Primary Location: Poughkeepsie, NY
(Remote considered)

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together.

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.

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

 Primary Responsibilities:

  • Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (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
  • 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF / AIR / LTAC, Emergency Department, Urgent Care, Doctor’s Office, School Nurse)
  • Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
  • Demonstrate a 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
  • Background (1+ years) that involves utilization review and evidence-based guidelines (InterQual Guidelines)
  • Compact license
  • 2+ years case management experience
  • Managed Care experience
  • Experience performing discharge planning
  • Ability to work independently
  • Demonstrated effective

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $56,300 to $110,400 annually. 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.