Inpatient Care Management Nurse RN - Remote in EST - UnitedHealth Group : Job Details

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 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 pr...RN, Patient Care, Management, Nurse, Medical Director, Patient, Healthcare