Introduction to Optum and Our Mission
Optum, a global leader in health care, is dedicated to delivering care, aided by technology, to help millions of people live healthier lives. Our organization is guided by a strong commitment to diversity and inclusion, fostering a culture where talented professionals can thrive. We offer comprehensive benefits, career development opportunities, and a collaborative environment that empowers our team members to make a meaningful impact on the communities we serve. As a Utilization Management Registered Nurse, you will play a vital role in advancing health equity on a global scale, connecting people with the care, pharmacy benefits, data, and resources they need to feel their best.
About the Role
As an Inpatient Care Management Nurse, you will be responsible for ensuring the proper utilization of our health services, 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, where you will have the opportunity to work with a talented team of professionals who share your passion for delivering high-quality patient care. You will be working remotely, with the flexibility to work from the comfort of your own home, while collaborating with our team to drive success and improve health outcomes.
Primary Responsibilities
In this role, you will be responsible for:
- Performing initial and concurrent review of inpatient cases, applying evidence-based criteria (InterQual criteria)
- Discussing cases with facility healthcare professionals to obtain plans-of-care
- Collaborating with Optum Enterprise Clinical Services Medical Directors on performing utilization management
- Participating in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
- Consulting with the Medical Director, as needed, for complex cases and making appropriate referrals to downstream partners
- Applying clinical expertise when discussing cases with internal and external Case Managers and Physicians
- Identifying delays in care or services and managing with MD
- Following all Standard Operating Procedures in end-to-end management of cases
- Obtaining clinical information to assess and expedite alternate levels of care
- Facilitating timely and appropriate care and effective discharge planning
- Participating in team meetings, education, discussions, and related activities
- Maintaining compliance with Federal, State, and accreditation organizations
- Identifying opportunities for improved communication or processes
- Participating in audit activities and meetings
Required Qualifications
To be successful in this role, you will need:
- A current, unrestricted RN license
- 3 years of clinical nursing experience practicing clinically (Acute Inpatient, SNF / AIR / LTAC, Emergency Department, Urgent Care, Doctor's Office, School Nurse)
- Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
- Demonstrated proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms
- A designated workspace and access to install secure high-speed internet via cable / DSL in your home
Preferred Qualifications
While not required, the following qualifications are preferred:
- A Bachelor's degree
- A compact license
- 2 years of case management experience
- Background (1 year) that involves utilization review and evidence-based guidelines (InterQual Guidelines)
- Managed Care experience
- Experience performing discharge planning
- Proven ability to work independently
- Demonstrated effective verbal and written communication skills
Skills and Competencies
To excel in this role, you will need to possess:
- Strong clinical knowledge and expertise
- Excellent communication and interpersonal skills
- Ability to work independently and as part of a team
- Strong problem-solving and analytical skills
- Ability to prioritize tasks and manage multiple projects simultaneously
- Strong attention to detail and organizational skills
Career Growth Opportunities and Learning Benefits
At Optum, we are committed to helping our team members grow and develop in their careers. As a Utilization Management Registered Nurse, you will have access to a range of learning and development opportunities, including:
- Professional development programs and training
- Mentorship and coaching from experienced professionals
- Opportunities to take on new challenges and responsibilities
- Support for continuing education and certification
Work Environment and Company Culture
Our company culture is built on a foundation of diversity, inclusion, and respect. We believe that everyone deserves the opportunity to live their healthiest life, and we are committed to creating a work environment that is supportive, inclusive, and empowering. As a Utilization Management Registered Nurse, you will be part of a talented team of professionals who share your passion for delivering high-quality patient care.
Compensation, Perks, and Benefits
We offer a competitive salary and benefits package, including:
- Comprehensive health insurance
- Retirement savings plan
- Opportunities for professional development and growth
- A supportive and inclusive work environment
Conclusion
If you are a motivated and compassionate Registered Nurse looking for a new challenge, we encourage you to apply for this exciting opportunity. As a Utilization Management Registered Nurse, you will have the chance to make a real difference in the lives of our members, while working with a talented team of professionals who share your passion for delivering high-quality patient care. Don't miss out on this opportunity to join our team and start making a positive impact on the communities we serve. Apply today and let's build the future together!
Apply Now