About the role
UnitedHealth Group's Optum division is hiring a remote Inpatient Care Management Nurse RN to perform utilization review on inpatient hospital cases using InterQual criteria. Based anywhere in the Eastern or Central time zones, the nurse works alongside Optum's Clinical Services team and Medical Directors to confirm the right level of care and keep discharge planning on track. The role requires a consistent Sunday–Thursday or Tuesday–Saturday schedule after training.
Responsibilities
- Perform initial and concurrent review of inpatient hospital cases using InterQual evidence-based criteria
- Discuss cases directly with facility healthcare professionals to confirm each patient's plan of care
- Partner with Optum Enterprise Clinical Services Medical Directors on utilization management decisions
- Participate in clinical services team discussions to keep patients progressing to the most appropriate level of care
- Consult the Medical Director on complex cases and route appropriate referrals to downstream partners
- Apply clinical judgment when coordinating with internal and external case managers and physicians
- Identify delays in care or services and escalate to the Medical Director as needed
- Facilitate timely, appropriate care and effective discharge planning while following standard operating procedures
Requirements
- Active, unrestricted RN license in your state of residence (compact RN license preferred)
- At least 1 year of recent clinical nursing experience in an acute inpatient hospital setting
- At least 1 year of utilization review experience using InterQual guidelines, either in a hospital or at a health insurance company
- Comfortable with core computer tools (Windows, Outlook, Excel, instant messaging, clinical platforms)
- A dedicated home workspace with secure high-speed internet
- Must live in the Eastern or Central time zone
- Bachelor's degree, 2+ years of acute inpatient case management/utilization review experience, and managed care experience are preferred
What we offer
- Comprehensive benefits package including incentive and recognition programs
- Equity stock purchase and 401(k) contribution
- Remote work flexibility under UnitedHealth Group's Telecommuter Policy