There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? 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 Manager you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready for a new path? Join us and start doing your life's best work.(sm)What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Primary Responsibilities: Perform utilization and concurrent review of inpatient cases using Milliman criteria 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 plan 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 and in-person staff meetings 75% Travel - Daily visit to various Skilled Nursing Facilities in Greenville county, SC area
Required Qualifications:A current, unrestricted RN license in South Carolina Demonstrate a proficiency in computer skills - windows, IM, excel (Microsoft suite), Outlook, clinical platforms Minimum of 3 years total RN experience including recent clinical experience in an inpatient / acute setting Experience in skilled nursing and / or acute rehabilitation facilities Ability to travel daily to various Skilled Nursing Facilities in the Greenville county, SC Must have a designated work space and access to install secure high speed internet via cable / DSL in homePreferred Qualifications:2 or more years of case management experience Case management certification and / or experience Experience in discharge planning and / or chart review Experience with utilization review for an insurance company or in a managed care environment Familiarity with Milliman criteria guidelines Managerial experience Bachelor's degreeCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm) 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. Job Keywords: RN, Registered Nurse, Care Manager, Skilled Nursing, Utilization Management, Greenville, SC
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.