Remote RN Clinical Review Coordinator – Nebraska

Optum

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Requisition Number: 2210056
Job Category: Medical & Clinical Operations
Primary Location: Omaha, NE
(Remote considered)

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

If you are located in the state of Nebraska, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Perform utilization and concurrent review of inpatient cases using InterQual care guidelines
  • 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
  • Consult with the Medical Director as needed to troubleshoot difficult or complex cases
  • Identify opportunities for improved communication or processes
  • Participate in telephonic staff meeting

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 in the state of Nebraska
  • 3+ years total RN experience including recent clinical experience
  • 3+ years of experience in pediatrics
  • Demonstrate a proficiency in computer skills – windows, IM, excel (Microsoft suite), Outlook, clinical platforms
  • Workspace 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)
  • 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
  • Permanent residence in the state of Nebraska

 

Preferred Qualifications:

  • Bachelor’s degree
  • CCM
  • Case Management experience
  • UM/UR experience including experience performing admission and continued inpatient stay reviews
  • Experience in acute long-term care, acute rehabilitation, or skilled nursing facilities
  • Experience in discharge planning and/or chart review
  • Experience with utilization review for an insurance company or in a managed care environment
  • Medicaid and Medicare insurance experience
  • Familiarity with InterQual care guidelines

 

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