As anInpatient 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 identifyingsolutions 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 doingyour 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.

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

"Work schedule will be 8a 5pm Monday to Friday,centraltime zone.

Primary Responsibilities:

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• Maintain appropriate and accurate documentation
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• PerforminitialandconcurrentreviewofinpatientcasesapplyingMCGcriteriaforapprovalandsendingtoMedicalDirectorsifreviewisnecessaryfordetermininganadversedetermination
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• Discusscaseswithfacilityhealthcareprofessionalstoobtainplans-of-care
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• CollaboratewithUnitedHealthcareMedicalDirectorsonperformingutilizationmanagement
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• ParticipationindiscussionswiththeClinicalServicesteamtoimprovetheprogressionofcaretothemostappropriatelevel
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• ConsultwiththeMedicalDirectorasneededforcomplexcasesandmakeappropriatereferralstosistersegments
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• ApplyclinicalexpertisewhendiscussingcasewithinternalandexternalCaseManagersandPhysicians
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• IdentifydelaysincareorservicesandmanagewithMD
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• FollowallStandardOperatingProceduresinendtoendmanagementofcases
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• Obtainclinicalinformationtoassessandexpeditealternatelevelsofcare
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• Facilitatetimelyandappropriatecareandeffectivedischargeplanning
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• Participateinteammeetings,educationdiscussionsandrelatedactivities
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• MaintaincompliancewithFederal,Stateandaccreditationorganizations
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• Identifyopportunitiesforimprovedcommunicationorprocesses
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• Participateintelephonicandin-personstaffmeetings
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• PlanforMCGCertification
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• Build and maintain relationships
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• Gather clinical information to assess and expedite care needs
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Youll 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:

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• A current, unrestricted RN license in state of residence
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• Minimum of 3 years total RN experience including recent clinical experience in an inpatient/acute setting
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• 1 year or more of UM/UR experience required including experience performing admission and continued inpatient stay reviews using either Interqual or MCG criteria.
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• MCG Certification or willing to obtain within one year of service
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• Demonstrate a proficiency in computer skills Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
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• Must have a designated work space and access to install secure high speed internet via cable/DSL in home
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• 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.
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Preferred Qualifications:

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• Experience in discharge planning and/or chart review
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• MCG Certification
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• Compact license
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• Experience with utilization review for an insurance company or in a managed care environment
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• Familiarity with Milliman criteria guidelines
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• Bachelors degree
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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 doyour life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Groups 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, Texas, TX