Inpatient Care Management Nurse RN - Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you’ll 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 inclusion, talented peers, comprehensive benefits, and career development opportunities.

There’s an energy and excitement here, a shared mission to improve the lives of others as well as our own. 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 includes assessing and interpreting member needs and identifying solutions that help our members live healthier lives.

Schedule will vary to include weekend requirements based on business needs.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

• Perform initial and concurrent review of inpatient cases applying evidenced‑based criteria (Inter Qual criteria)
• Discuss cases with facility healthcare professionals to obtain plans‑of‑care
• Collaborate with Optum Enterprise Clinical Services 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 downstream partners
• 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 audit activities and meetings

• Active, unrestricted RN license in state of residence
• 1+ years of clinical nursing experience in a Hospital setting
• 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

• Bachelor’s degree
• Compact RN license
• 2+ years of acute inpatient case management experience/utilization review
• 1+ years of experience in Utilization Review, either within an Acute Inpatient Hospital setting or within a health insurance company
• Managed care experience
• Experience performing discharge planning

* All employees working remotely will be required to adhere to United Health Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment.

United Health Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

United Health Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.