Concurrent Review RN Corona CA
Unitedhealth Group
Registered Nurse Job in Corona, CA
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing **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 + RN 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 at OptumCare.** We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do **your life's best work.(sm)** OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians. _Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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._ _OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._