Inpatient Care Management Nurse TX Market

About the position 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 resources 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. As an Inpatient Care Management Nurse, 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. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. Work hours will be Monday to Friday 8:00 AM - 5:00 PM in business time zone, and you'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. 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 , • Provide 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 , • 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 • Current, unrestricted RN license in the state of residence , • TX or compact RN license , • 3+ years of acute care clinical nursing experience , • 1+ years of utilization review experience using evidence-based guidelines , • Demonstrate a proficiency in computer skills - Windows, Teams, Excel (Microsoft Suite), Outlook, clinical platforms , • Designated workspace and access to install secure high-speed internet via cable / DSL in home Nice-to-haves • Bachelor's degree/ BSN , • Compact license , • Managed Care experience , • Experience performing discharge planning Benefits • Comprehensive benefits package , • Incentive and recognition programs , • Equity stock purchase , • 401k contribution Apply Job!