For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

　　If you are located in the state of Tennessee, you will have the flexibility to work remotely* as you take on some tough challenges.

　　Primary Responsibilities:

　　Perform utilization and concurrent review of inpatient cases using InterQual care guidelines

　　Conduct clinical chart assessments

　　Build and maintain relationships

　　Discuss cases with treating physicians and other healthcare professionals to better understand plans-of-care

　　Participate in rounds with the Medical Director and discussing cases as needed

　　Determine need, if any, for intervention and discussing with Case Managers and physicians

　　Identify and evaluate delays in care

　　Initiate a discharge planning and readmission prevention plan

　　Approve bed days for inpatient cases (when applicable)

　　Arrange alternative care services; contact and maintain communication with acute long-term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum

　　Gather clinical information to assess and expedite care needs

　　Facilitate timely and appropriate care and effective discharge planning

　　Participate in team meetings, education discussions, and related activities

　　Maintain appropriate documentation

　　Consult with the Medical Director as needed to troubleshoot difficult or complex cases

　　Identify opportunities for improved communication or processes

　　Participate in telephonic staff meeting

　　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.

　　Required Qualifications:

　　Current, unrestricted RN license in the state of Tennessee

　　Permanent residence in the state of Tennessee

　　3+ years total RN experience including recent clinical experience

　　Demonstrate a proficiency in computer skills - windows, IM, excel (Microsoft suite), Outlook, clinical platforms

　　Workspace in their home that is separated from non-workspace areas and that can be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI)

　　Living in a location that can receive high - speed internet service with a minimum speed of 5 download mps & 1 upload mps. Mobile cellular data, e.g., fixed wireless, air cards / MiFi devices, and satellite are not approved means of internet connectivity and do not meet the criteria for high-speed internet connection through an Internet Service Provider

　　Preferred Qualifications:

　　Bachelor’s degree

　　CCM

　　Case Management experience

　　UM/UR experience including experience performing admission and continued inpatient stay reviews

　　Experience in acute long-term care, acute rehabilitation, or skilled nursing facilities

　　Experience in discharge planning and/or chart review

　　Experience with utilization review for an insurance company or in a managed care environment

　　Medicaid and Medicare insurance experience

　　Familiarity with InterQual care guidelines

　　*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

　　At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission .

　　Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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 .

　　OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.