Inpatient Care Management Nurse RN - Remote in EST
– Amazon Store
Skip to content
About the position
Responsibilities
Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria)
Discuss cases with facility healthcare professionals to obtain plans-of-care
Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management
Participate 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 downstream partners
Apply clinical expertise when discussing cases 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 audit activities and meetings
Requirements
Active, unrestricted RN license in state of residence
3+ years of clinical nursing experience in an Acute Inpatient Hospital setting
1+ year of experience in Utilization Review utilizing InterQual Guidelines, either within an Acute Inpatient Hospital setting or within a health insurance company
