UnitedHealthcare Military and Veterans is currently seeking Inpatient Case Management Nurses for our Utilization Management department. The Inpatient Case Management Nurse is responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). The ICM Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescribed. The ICM Nurse works under the direct supervision of an RN or MD.
Primary duties of the Inpatient Case Management (ICM) Nurse:
- Performing care management activities to ensure that patients move through the continuum of care efficiently and safely
- Assesses and interprets customer needs and requirements
- Reviewing cases and analyzing clinical information in conjunction with Medical Directors to determine the appropriateness of hospitalization
- Performing Nurse to Physician interaction to acquire additional clinical information or discuss alternatives to current treatment plan.
- Escalating cases to the Medical Director for case discussion or peer-to-peer intervention as appropriate
- Performing anticipatory discharge planning in accordance with the patient's benefits and available alternative resources
- Referring patients to disease management or case management programs
- Assisting with the development of treatment plans
- Documenting activities according to established standards
- Identifies solutions to non-standard requests and problems
- Solves moderately complex problems and/or conducts moderately complex analyses
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Provides explanations and information to others on difficult issues
- Acts as a resource for others with less experience
- Works with less structured, more complex issues
- Current and unrestricted RN License in state of residence
- Minimum 3 years of clinical experience in an inpatient/acute setting
- 2+ years of Utilization Review experience
- United States Citizenship
- Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86
- Strong organizational skills
- Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans,
- Drive performance and achieve targets
- Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
- Intermediate to Advanced computer skills-Microsoft Word, Outlook and Internet Explorer, with the ability to navigate a Windows environment
As a requirement of UnitedHealth Groupâ€™s contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 http://www.opm.gov/forms/pdf_fill/sf86.pdf, (the National Agency Check or â€œNACâ€). Successful completion of the NAC process is a requirement for continued employment in this role. NAC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense. Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received. Failure to obtain final NAC approval will result in termination from this role.
- Previous TRICARE Experience
- Knowledge of Milliman Care Guidelines
- Experience in discharge planning and/or chart review is desired
- Experience in acute long term care, acute rehabilitation, or skilled nursing facilities is desired
- A background that involves utilization review for an insurance company or in a managed care environment is desired
- A Bachelor's degree is preferred
Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. Thatâ€™s why UnitedHealthcare is the organization thatâ€™s called on to serve them and their loved ones. Weâ€™re all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. Itâ€™s a genuine opportunity to do your lifeâ€™s best work.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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