Hershey, Pennsylvania
Sevierville, Tennessee, Tennessee
Smithfield, North Carolina
Hershey, Pennsylvania
Bloomington, Indiana
Posted: 27-Nov-24
Location: Greenville, South Carolina
Categories:
Internal Number: 144765118
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 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.
Primary Responsibilities:
- Perform initial and concurrent review of inpatient cases applying MCG criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
- Discuss cases with facility healthcare professionals to obtain plans-of-care
- Collaborate with UnitedHealthcare 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 sister segments
- 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 telephonic and in-person staff meetings
- Plan for MCG Certification
This position does require you to work a weekend (Saturday-Sunday) rotation throughout the year. If you work a weekend day you will receive a day-off during the week and differential pay for the weekend day you work.
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 resident state
- 3+ years of total experience, including recent clinical experience in an inpatient/acute setting
- Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
- Experience performing discharge planning
- Experience in utilization review and/or utilization management
- Solid computer skills
Preferred Qualifications:
- Bachelor’s degree
- Experience with MCG Guidelines or InterQual
- Demonstrated ability to work independently
- Demonstrated effective verbal and written communication skills
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: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
