Inpatient Care Management Nurse RN - Hawaii Telecommute
Location: Honolulu, Hawaii
Internal Number: 107496967
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)
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.
This is a telecommute position and candidate must be willing to work 8 AM – 5 PM Hawaii time zone hours. An alternative work schedule of 4 ten hour days may be an option.
Perform initial and concurrent review of inpatient cases applying evidence based criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
Discuss cases with facility healthcare professionals to obtain plans-of-care
Collaborate with UnitedHealthcare 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 sister segments
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 telephonic and in-person staff meetings
Plan for 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.
A current, unrestricted RN license in State of Hawaii
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
Reside in of Hawaii
1+ years of experience involving utilization review and evidence-based guidelines (i.e. MCG, InterQual Guidelines)
Experience in discharge planning and/or chart review
Experience with utilization review for an insurance company or in a managed care environment
Familiarity with InterQual criteria guidelines
Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
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.
The National Association of Nurse Practitioners in Women's Health's (NPWH) mission is to ensure the provision of quality primary and specialty healthcare to women of all ages by women's health and women's health focused nurse practitioners.