Remote Utilization Review Rn Jobs in Madison, WI

$10,000 Sign-on Bonus for External Candidates

Telephonic After-Hours Call - Evenings, Nights & Rotating Weekends Required 

Full Time (40 Hours)

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. 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 Full Time, work from home position requiring various shift coverage with a mix of weekday, weeknights, weekend, and holiday coverage. While shift times can vary, we provide coverage to members 24/7 including all company recognized holidays.

• Flexibility and the ability to adapt are a must as you will cross cover multiple markets and teams 

• Availability and Coverage expectations for this role 

  • 24/7 coverage
  • Position requires a minimum commitment of 40 hours per week
  • Every other weekend coverage between 8-12 hour shifts covering both day and night shifts is required based on business needs
  • Expectations that your are working or have approved PTO for 26 weekends a year. Each FT/PT employee is eligible to have up to 6 weekend shifts a year for PTO
  • Unapproved time away/Unpaid Time Off will result in need to add additional weekend shift to your schedule based on need
• Holidays are required for all APCs on a rotation basis

• 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

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:

• Education:
  • 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 States of Ohio, Missouri, Indiana or Wisconsin, and ability to obtain in other required locations
• Ability to gain a collaborative practice agreement, if applicable in your state
• If you're working in a state that allows NPs/PAs to practice independently (without Collaborative Agreement), you must get approval from your licensing board-if required. New hires who are eligible but haven't applied yet must do so within 1 month of starting. If you're not eligible at the time of hire, you must begin working toward eligibility within 1 month and apply for approval within 3 months of becoming eligible
• 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
• Current, active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice)
• 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: