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TRICARE Inpatient - RN Nurse Case Manager -€“ Honolulu, Hawaii
UnitedHealthcare Military and Veterans is currently seeking Inpatient Case Management Nurses for our Utilization Management department. The Inpatient Case Management Nurse is responsible for utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management). The ICM Nurse will performs reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and not prescribed. The ICM Nurse works under the direct supervision of an RN or MD.
Primary Duties Of The Inpatient Case Management (ICM) Nurse
Performing care management activities to ensure that patients move through the continuum of care efficiently and safely
Assesses and interprets customer needs and requirements
Reviewing cases and analyzing clinical information in conjunction with Medical Directors to determine the appropriateness of hospitalization
Performing Nurse to Physician interaction to acquire additional clinical information or discuss alternatives to current treatment plan.
Escalating cases to the Medical Director for case discussion or peer-to-peer intervention as appropriate
Performing anticipatory discharge planning in accordance with the patient's benefits and available alternative resources
Referring patients to disease management or case management programs
Assisting with the development of treatment plans
Documenting activities according to established standards
Identifies solutions to non-standard requests and problems
Solves moderately complex problems and/or conducts moderately complex analyses
Works with minimal guidance; seeks guidance on only the most complex tasks
Provides explanations and information to others on difficult issues
Acts as a resource for others with less experience
Works with less structured, more complex issues
Current and unrestricted RN License in state of residence
Minimum 3 years of clinical experience in an inpatient/acute setting
2+ years of Utilization Review experience
United States Citizenship
Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86
Strong organizational skills
Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans,
Drive performance and achieve targets
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Intermediate to Advanced computer skills-Microsoft Word, Outlook and Internet Explorer, with the ability to navigate a Windows environment
Knowledge Of Milliman Care Guidelines
Experience in discharge planning and/or chart review is desired
Experience in acute long term care, acute rehabilitation, or skilled nursing facilities is desired
A background that involves utilization review for an insurance company or in a managed care environment is desired
A Bachelor's degree is preferred
As a requirement of UnitedHealth Group's contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 http://www.opm.gov/forms/pdf_fill/sf86.pdf, (the National Agency Check or 'NAC'). Successful completion of the NAC process is a requirement for continued employment in this role. NAC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense. Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received. Failure to obtain final NAC approval will result in termination from this role.
Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. That's why UnitedHealthcare is the organization that's called on to serve them and their loved ones. We're all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. It's a genuine opportunity to do your life's best work.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.
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.