Ohio Nurses Association

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

This position facilitates cost effective care throughout the continuum utilizing a collaborative multi-disciplinary approach. Implements the nursing process including assessment, planning, implementing, coordinating, monitoring, and evaluating options and services for patients and families experiencing complex/catastrophic illnesses. Responsible for the assurance of quality medical management and cost containment in the Utilization (Medical) Management department in the PMG/IPA. This includes but is not limited to utilization and referral management and total case management, in both the inpatient and outpatient settings.

Primary Responsibilities:

• Daily onsite rounds, reviewing of medical records, concurrent review, and discharge planning on inpatients with arrival at facilities in the morning ideally between 0800 and 0900
• Daily inpatient rounds with Hospitalists
• Communicates discharges to IPA by 12 noon
• Reviews inpatient cases with UM Manager daily
• Documents Milliman Guideline(s) on every inpatient case within 24 hours of receipt and updates guideline as hospitalization continues
• Notifies patient’s Primary Care Physician of admission, discharge, and discharge plan within 24 hours of each event as appropriate
• Analyzes medical cases for appropriateness and plans and coordinates all phases of care in conjunction with the Hospitalist, attending Physician, Specialists both in the inpatient and outpatient settings
• Utilizes the nursing process to establish individual patient goals and measures patients’ response to the plan of care for appropriate outcomes and intervenes appropriately
• Collaborates with physicians, patients, and families to formulate an optimal plan of care that meets all the medical, psychosocial, and financial needs of the patient
• Explores care options to reduce cost, decrease length of stay, curtail re-admission and influence quality outcomes
• Understands capitation vs. fee for service
• Knowledgeable regarding network providers and current contracted specialists
• Manages cases according to delegation agreement requirements, including notifications regarding LOS >5 days
• Regularly communicates with Health Plans as appropriate
• Other duties as required

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Associate Degree
• LVN with current California license
• 2+ years of clinical experience in acute care (i.e., ICU, CCU, ER, med-surg)
• 1+ years managed care experience
• Computer literate in Microsoft Word
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• Bachelor’s Degree
• Concurrent review experience

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.