Inpatient Care Management Nurse RN

About the position

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
• 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 downstream partners
• 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 audit activities and meetings

Requirements

• Active, unrestricted RN license in state of residence
• 3+ years of clinical nursing experience in an Acute Inpatient Hospital setting
• 1+ year of experience in Utilization Review utilizing InterQual Guidelines, either within an Acute Inpatient Hospital setting or within a health insurance company
• 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
• Permanent residence in Eastern Standard Time or Central Standard Time zones

Nice-to-haves

• Bachelor’s degree
• Compact RN license
• 2+ years acute inpatient case management experience/Utilization Reviewer
• Managed care experience
• Experience performing discharge planning

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution