Inpatient Care Manager RN - Telephonic Review - Washington

*** Must reside in the state of Washington. This is a work from home position***

Responsibilities: 

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  Performing utilization and concurrent review of inpatient cases using Milliman and/or InterQual criteria


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  Conducting clinical chart assessments


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  Discussing cases with treating physicians and other healthcare professionals to better understand plans-of-care


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  Participating in telephonic rounds with the Medical Director and discussing cases as needed


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  Determining need, if any, for intervention, and discussing with Case Managers and physicians


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   Identifying and evaluating delays in care


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  Initiating a discharge planning and readmission prevention plan


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  Approving bed days for inpatient cases (when applicable)


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  Arranging alternative care services; Contacting and maintaining communication with acute long term care, acute rehabilitation, or skilled nursing facilities to move patients through the care continuum


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  Gathering clinical information to assess and expedite care needs


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  Facilitating timely and appropriate care and effective discharge planning


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   Participating in team meetings, education discussions and related activities


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  Maintaining appropriate documentation


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  Consulting with the Medical Director as needed to troubleshoot difficult or complex cases


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   Identifying opportunities for improved communication or processes


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  Participating in telephonic staff meetings

• Current unrestricted RN license for the state of Washington is required


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  Minimum of 5 years total experience including clinical experience in an inpatient/acute setting preferred


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  Experience in discharge planning and/or chart review preferred


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  Background that involves utilization review for an insurance company or in a managed care environment would be preferred


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  Familiarity with Milliman criteria guidelines and/or Interqual would be helpful


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  Case management certification and/or experience is preferred


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  Intermediate computer skills


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  Ability to build and maintain relationships will be essential


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  Managerial background is a plus


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  Bachelor's degree is ideal

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Key Words: Tacoma, Yakima, Seattle, RN, nurse, utilization review, concurrent review, care manager, Milliman, InterQual