Remote Utilization Review Nurse Jobs in Rochester, NH

Sign On Bonus Available for External Candidates

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Optum team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. We're connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.

The Telehealth Urgent Care program is a comprehensive integrated care delivery program. The National On Call advanced practice clinician (APC) is responsible for providing telephonic/telehealth care and direction to patients, caregivers and facility staff providing 24/7 coverage including holidays.

In this remote role you will provide virtual care for patients in various settings. This excellent opportunity affords a collaborative role bringing enormous satisfaction in the care and comfort of our patients. In this role you will have the ability to achieve work life balance. Optum is transforming care delivery with innovative and personal care. As one of the largest employers of APCs, Optum offers unparalleled career development opportunities.

Scheduling:

This is a Per Diem, work from home position. While shift times can vary, we provide coverage to members 24/7 including all company recognized holidays.

Availability and Coverage expectations for this role 

• Position requires a minimum commitment of 32 hours per month
• Additional availability of a minimum of 12 hours per month
• Holiday coverage is required by all APCs and is provided beginning at 5pm, the end of the last business day to 8am of the resumption of business hours
• Holiday scheduling is completed at the beginning of the year for advanced planning. Holiday coverage is provided beginning at 5pm, the end of the last business day, to 8am of the resumption of business hours
• (1) 8-hour summer holiday (Memorial Day, Labor Day, or July 4th)
• (1) 8- hour winter holiday (Thanksgiving, Day After Thanksgiving, Christmas, or NYD)
• Premium pay is paid for holiday coverage

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Available on provided telephonic platform, both taking and placing calls to coordinate and manage care for members between care givers, facilities, hospitals, primary care providers and the Optum field colleagues
• Available to use video platform based on clinical need
• Working hours should be performed in a secure location as patient privacy is required
• Utilize EMR proficiently to provide acute care to members during all shifts and holiday hours
• Care Delivery  
  • Deliver cost-effective, quality care to members
  • Manage both medical and behavioral, chronic, and acute conditions effectively, and in collaboration with a physician or specialty provider
  • Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • Responsible for ensuring encounter is documented appropriately to support the diagnosis at that visit
  • The APC is responsible for ensuring that all quality elements are addressed and documented
  • Utilizes evidenced based practice guidelines
  • Must attend and complete all mandatory educational and MyLearning training requirements
• Care Coordination
  • Coordinate care as members transition through different levels of care and care settings
  • Monitor the needs of members and families while facilitating any adjustments to the plan of care as situations and conditions change
  • Review orders and interventions for appropriateness and response to treatment to identify the most effective plan of care that aligns with the patients' needs and wishes
  • Address and be able to have advanced care plan conversations with members and families
  • Evaluate the plan of care for cost effectiveness while meeting the needs of members, families, and providers to decrease high costs, poor outcomes and unnecessary hospitalizations
• Program Enhancement Expected Behaviors  
  • This is a virtual patient facing role that requires excellent customer service to all parties including members/families, facilities, the entire interdisciplinary care team (PCPs/specialists) and Optum staff
  • Regular and effective communication with internal and external parties including physicians, patients, key decision-makers, nursing facilities, field staff and other provider groups
  • Ability to meet shift scheduling requirements, and attendance expectations
  • Exhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issues
  • Function independently and responsibly with minimal need for supervision
  • Demonstrate initiative in achieving individual, team, and organizational goals and objectives
  • Participate in quality initiatives
  • Availability to check Optum email intermittently for required trainings, communications, and monthly scheduling.

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:

• NP: Graduate of an accredited Master of Science Nursing or Doctor of Nursing Practice program
• Active and unrestricted license in the state which you reside, as well as State of (CT, NY, NH, ME, RI, NJ), and ability to obtain in other required locations. Note: we will consider internal redeployed talent who are open to obtaining an active license in the State of (CT, NY, NH, ME, RI, NJ) within 90 days of start date
• Current, active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)
• Active Nurse Practitioner certification through a national board
• NP: Board certified through the American Academy of Nurse Practitioners or the American Nurses Credentialing Center, with certification in one of the following:
  • Family Nurse Practitioner
  • Adult Nurse Practitioner
  • Gerontology Nurse Practitioner
  • Adult-Gerontology Acute Care Nurse Practitioner
• Ability to gain a collaborative practice agreement, if applicable in your state.
• APCs working in jurisdictions that authorize APCs to practice autonomously or without formal supervision must have obtained approval to practice autonomously or without formal supervision from their licensing board, if applicable. New hires who are eligible and have not applied prior to hire date, must apply to practice autonomously or without supervision within 1 month of hire. If not eligible to practice autonomously or without formal supervision at hire, the APC must begin working towards meeting the requirement within 1 month of hire, if applicable, and apply for approval to practice autonomously or without formal supervision within 3 months of becoming eligible
• UnitedHealth Group will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment
• UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
• Ability to work scheduled shifts in accordance with scheduling policies
• Proficient computer skills including the ability to document medical information with written and electronic medical records

Preferred Qualifications:

• 3+ years of clinical experience as an APC
• Experience in meeting the medical needs of patients with complex behavioral, social and/or functional needs
• Experience working in a nursing home, or with seniors in an acute care facility
• Understanding of Geriatrics, Chronic Illness, and acute disease management
• Understanding of Advanced Illness and end of life discussions
• Ability to develop and maintain positive customer relationships
• Adaptability to change

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Compensation for this specialty generally ranges from $53.00 - $79.00 per hour. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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