Inpatient Care Management Nurse RN

Inpatient Care Management Nurse RN - Remote in EST – Amazon Store Skip to content September 8, 2025 About the positionResponsibilities Perform initial and concurrent review of inpatient cases applying evidenced-based criteria (InterQual criteria) Discuss cases with facility healthcare professionals to obtain plans-of-care Collaborate with Optum Enterprise Clinical Services Medical Directors on performing utilization management Participate in discussions with the Clinical Services team to improve the progression of care to the most appropriate level Consult with the Medical Director, as needed, for complex cases and make appropriate referrals to downstream partners Apply clinical expertise when discussing cases with internal and external Case Managers and Physicians Identify delays in care or services and manage with MD Follow all Standard Operating Procedures in end to end management of cases Obtain clinical information to assess and expedite alternate levels of care Facilitate timely and appropriate care and effective discharge planning Participate in team meetings, education, discussions, and related activities Maintain compliance with Federal, State and accreditation organizations Identify opportunities for improved communication or processes Participate in audit activities and meetings Requirements Active, unrestricted RN license in state of residence 3+ years of clinical nursing experience in an Acute Inpatient Hospital setting 1+ year of experience in Utilization Review utilizing InterQual Guidelines, either within an Acute Inpatient Hospital setting or within a health insurance company Proficiency in computer skills - Windows, IM, Excel (Microsoft Suite), Outlook, clinical platforms Designated workspace and access to install secure high-speed internet via cable / DSL in home Permanent residence in Eastern Standard Time or Central Standard Time zones Nice-to-haves Bachelor's degree Compact RN license 2+ years acute inpatient case management experience/Utilization Reviewer Managed care experience Experience performing discharge planning Benefits Comprehensive benefits package Incentive and recognition programs Equity stock purchase 401k contribution Choosing a selection results in a full page refresh. Opens in a new window. apply to this job