Remote Inpatient RN Case Manager, Optum
About the position
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. 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. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Responsibilities
Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria)
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Discuss cases with facility healthcare professionals to obtain plans-of-care
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Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management
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Participate in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
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Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners
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Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
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Identify delays in care or services and manage with MD
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Follow all Standard Operating Procedures in end to end management of cases
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Facilitate timely and appropriate care and effective discharge planning
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Participate in team meetings, education, discussions, and related activities
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Maintain compliance with Federal, State and accreditation organizations
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Identify opportunities for improved communication or processes
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Participate in audit activities and meetings
Requirements
Current, unrestricted RN license in the state of residence
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2+ years of acute care clinical nursing experience
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Designated workspace and access to install secure high-speed internet via cable / DSL in home
Nice-to-haves
1+ years of utilization management experience using evidence-based guidelines
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Pre-authorization experience
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Case Management experience
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Knowledge of Milliman or Interqual criteria
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Demonstrate a proficiency in computer skills - Windows, Teams, Excel (Microsoft Suite), Outlook, clinical platforms
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Cable internet availability
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Experience performing discharge planning
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Ability to work independently
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Demonstrated effective verbal and written communication skills
Benefits
Comprehensive benefits package
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Incentive and recognition programs
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Equity stock purchase
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401k contribution
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