Registered Nurse jobs at Humana

The CRC Auditor, conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims, were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and / or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and patterns to the CRC leadership. Provides expert application of evidence based medical necessity review criteria tool. Works collaboratively to review, evaluate and improve the denial appeal process. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Formulates and submits letters of appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines and coding guidelines, evidence-based medicine, community and national medical management and coding standards and protocols. * Performs reviews of accounts denied for DRG validation and DRG downgrades. * Documents in appropriate denial tracking tool (ACE). Maintains and distributes reports as needed to leadership. * Identifies payment methodology of accounts including Managed Care contract rates, Medicare and State Funded rates, Per-Diems, DRG's, Outlier Payments, and Stop Loss calculations. * Collaborates with Physician Advisors and CRC leadership when documentation-specific areas of concern are identified. * Maintains expertise in clinical areas and current trends in healthcare, inpatient coding and reimbursement methodologies and utilization management specialty areas. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Effectively organizes work priorities * Demonstrates compliance with departmental safety and security policies and practices * Demonstrates critical thinking, analytical skills, and ability to resolve problems * Demonstrates ability to handle multiple assignments and carry out work independently with minimal supervision * Demonstrates quality proficiency by maintaining accuracy at unit standard key performance indicator goals * Possesses excellent written and verbal communication skills * Detail oriented and ability to work independently and in a team setting * Moderate skills in MS Excel and PowerPoint, MS Office * Ability to research difficult coding and documentation issues and follow through to resolution * Ability to work in a virtual setting under minimal supervision * Ability to conduct research regarding state/federal guidelines and applicable regulatory guidelines related to government audit processes Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Includes minimum education, technical training, and/or experience required to perform the job. Education * Minimum Required: * Completion of BSN Degree Program or three years of experience and completion of BSN within five years of employment * RN License in the State of Practice * Current working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement. * Preferred/Desired: * Completion of BSN Degree Program * CCDS certification or inpatient coding certification Experience * Minimum Required: * Three to Five years Clinical RN Experience * Three to Five years of Clinical Documentation Integrity experience * Must have expertise with Interqual and/or MCG Disease Management Ideologies * Strong communication (verbal/written) and interpersonal skills * Knowledge of CMS regulations * Knowledge of inpatient coding guidelines * 1-2 years of current experience with reimbursement methodologies * Preferred/Desired: * Experience preparing appeals for clinical denials related to DRG assignment. * Strong understanding of rules and guidelines, including AHA's Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS CERTIFICATES, LICENSES, REGISTRATIONS * Required: * RN, * CCDS or other related clinical documentation specialist certification, and/or AHIMA or AAPC Coding Credential CCS, CCA, CIC, CPC or CPMA * Preferred: BSN PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to lift 15-30lbs * Ability to travel approximately 10% of the time; either to client sites, National Insurance Center (NIC) sites, Headquarters, or other designated sites * Ability to sit and work at a computer for a prolonged period of time conducting medical record quality reviews WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER * Interaction with facility HIM and / or physician advisors * Must meet the requirements of the Conifer Telecommuting Policy and Procedure As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $56,784.00 - $85,176.00 annually. Compensation depends on location, qualifications, and experience. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The CRC Auditor, conducts coding and documentation quality reviews and generates responses for cases that have been denied by commercial and government payors to ensure hospital inpatient, outpatient, and pro-fee claims, were coded and billed in accordance with nationally recognized coding guidelines, standards, regulations and regulatory requirements, as well as payor and billing guidelines. The responses generated by the Auditor may include system documentation of findings and / or a formal appeal letter. The Auditor will escalate trends to CRC leadership, Conifer Quality & Performance leadership and Conifer Compliance as warranted. The Auditor will perform analysis on clinical documentation, evidenced based criteria application outcome, physician documentation, physician advisor input and complete review of the medical record related to clinical denials. Assures appropriate action is taken within appeal time frames. Communicates identified denial trends and patterns to the CRC leadership. Provides expert application of evidence based medical necessity review criteria tool. Works collaboratively to review, evaluate and improve the denial appeal process. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. * Formulates and submits letters of appeal. Creates an effective appeal utilizing relevant and effective clinical documentation from the medical record; supported by current industry clinical guidelines and coding guidelines, evidence-based medicine, community and national medical management and coding standards and protocols. * Performs reviews of accounts denied for DRG validation and DRG downgrades. * Documents in appropriate denial tracking tool (ACE). Maintains and distributes reports as needed to leadership. * Identifies payment methodology of accounts including Managed Care contract rates, Medicare and State Funded rates, Per-Diems, DRG's, Outlier Payments, and Stop Loss calculations. * Collaborates with Physician Advisors and CRC leadership when documentation-specific areas of concern are identified. * Maintains expertise in clinical areas and current trends in healthcare, inpatient coding and reimbursement methodologies and utilization management specialty areas. KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Effectively organizes work priorities * Demonstrates compliance with departmental safety and security policies and practices * Demonstrates critical thinking, analytical skills, and ability to resolve problems * Demonstrates ability to handle multiple assignments and carry out work independently with minimal supervision * Demonstrates quality proficiency by maintaining accuracy at unit standard key performance indicator goals * Possesses excellent written and verbal communication skills * Detail oriented and ability to work independently and in a team setting * Moderate skills in MS Excel and PowerPoint, MS Office * Ability to research difficult coding and documentation issues and follow through to resolution * Ability to work in a virtual setting under minimal supervision * Ability to conduct research regarding state/federal guidelines and applicable regulatory guidelines related to government audit processes Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Includes minimum education, technical training, and/or experience required to perform the job. Education * Minimum Required: * Completion of BSN Degree Program or three years of experience and completion of BSN within five years of employment * RN License in the State of Practice * Current working knowledge of clinical documentation and inpatient coding, discharge planning, utilization management, case management, performance improvement and managed care reimbursement. * Preferred/Desired: * Completion of BSN Degree Program * CCDS certification or inpatient coding certification Experience * Minimum Required: * Three to Five years Clinical RN Experience * Three to Five years of Clinical Documentation Integrity experience * Must have expertise with Interqual and/or MCG Disease Management Ideologies * Strong communication (verbal/written) and interpersonal skills * Knowledge of CMS regulations * Knowledge of inpatient coding guidelines * 1-2 years of current experience with reimbursement methodologies * Preferred/Desired: * Experience preparing appeals for clinical denials related to DRG assignment. * Strong understanding of rules and guidelines, including AHA's Coding Clinics, American Association of Medical Audit Specialists (AAMAS), National Commission on Insurance Guidelines and Medicare Billing Guidelines (CMS), State Funded Billing Regulations (Arizona, California, Nevada) and grievance process; working knowledge of billing codes such as RBRVS, CPT, ICD-10, HCPCS CERTIFICATES, LICENSES, REGISTRATIONS * Required: * RN, * CCDS or other related clinical documentation specialist certification, and/or AHIMA or AAPC Coding Credential CCS, CCA, CIC, CPC or CPMA * Preferred: BSN PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to lift 15-30lbs * Ability to travel approximately 10% of the time; either to client sites, National Insurance Center (NIC) sites, Headquarters, or other designated sites * Ability to sit and work at a computer for a prolonged period of time conducting medical record quality reviews WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER * Interaction with facility HIM and / or physician advisors * Must meet the requirements of the Conifer Telecommuting Policy and Procedure As a part of the Tenet and Catholic Health Initiatives family, Conifer Health brings 30 years of healthcare industry expertise to clients in more than 135 local regions nationwide. We help our clients strengthen their financial and clinical performance, serve their communities and succeed at the business of healthcare. Conifer Health helps organizations transition from volume to value-based care, enhance the consumer and patient healthcare experience and improve quality, cost and access to healthcare. Are you ready to be part of our solutions? Welcome to the company that gives you the resources and incentives to redefine healthcare services, with a competitive benefits package and leadership to take your career to the next step! Compensation and Benefit Information Compensation * Pay: $56,784.00 - $85,176.00 annually. Compensation depends on location, qualifications, and experience. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********

The Transfer Center RN is responsible for coordinating direct admissions and hospital transfers to and from community hospitals with the intent to transfer each patient to an appropriate Tenet hospital. The position works collaboratively to foster relationships with referring facilities, physicians, and hospital staffs in representation of Tenet Healthcare Mission and Values. EDUCATION: Minimum: Education recognized by the State of Florida as qualification for Registered Nurse licensure. Preferred: BSN EXPERIENCE: Minimum of four (4) years clinical experience in an acute care setting, to include Charge Nurse, House Supervisor or other related management experience. REQUIRED CERTIFICATION/LICENSURE/REGISTRATION: Registered Nurse - licensed in the State of Florida. OTHER QUALIFICATIONS: · RN experience in an ER/ Critical Care. · Demonstrated professional leadership skills that include problem resolution capabilities. Demonstrated ability to handle multiple tasks and remain flexible. · Computer literacy in EMR's, Word Processing, and Excel spread sheets. #LI-HB1

The Transfer Coordinator - RN is responsible for coordinating patient transfers and admissions into and out of CHS facilities. This role performs initial admission screening using approved clinical criteria, ensuring each transfer aligns with policy and clinical standards. The Transfer Coordinator works closely with the Bed/Capacity Coordinator, hospital departments, and external healthcare providers to facilitate efficient patient flow and address barriers to patient throughput. Essential Functions Coordinates all aspects of patient transfers, admissions, or consultations from referring facilities, ensuring appropriate level of care and transport. Conducts admission screening using approved criteria to verify appropriateness of care level and bed assignments. Collaborates with Bed/Capacity Coordinator to prioritize transfers, bed assignments, and ensure patient information accuracy. Acts as a liaison between physicians, healthcare providers, patients, and families to streamline the admission/transfer process. Maintains and updates the Electronic Health Record (EHR) with accurate patient transfer information and outcomes. Identifies barriers to patient throughput, tracks trends, and recommends actions to improve efficiency and patient flow. Complies with regulatory and CHS policy standards, including EMTALA and quality initiatives, while adapting processes to ensure compliance. Utilizes medical necessity criteria to evaluate admissions, ensuring bed types and patient statuses are appropriate. Builds and maintains collaborative relationships with hospital staff, nursing units, and external healthcare providers to support quality patient care. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications Associate Degree in Nursing required Bachelor's Degree in Nursing preferred 1-3 years of clinical nursing experience in an acute care setting required Prior experience in transfer coordination or patient flow in ED or Critical Care preferred Knowledge, Skills and Abilities Strong clinical assessment and decision-making skills for managing patient transfers. Knowledge of healthcare regulations, including EMTALA and medical necessity guidelines. Excellent communication skills and ability to work effectively with multidisciplinary teams. Strong organizational skills with the ability to prioritize multiple tasks in a dynamic environment. Proficient in using electronic health record systems and standard office software. Ability to provide superior customer service and facilitate positive patient experiences. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of Tennessee required

The Registered Nurse (RN) provides patient-centered care through the nursing process of assessment, diagnosis, planning, implementation, and evaluation. This role is responsible for coordinating and delivering high-quality care based on established clinical protocols and physician/provider orders. The RN collaborates with physicians, nurses, and other healthcare professionals to ensure effective patient care and desired outcomes, while maintaining a supportive and compassionate environment for patients and their families. Essential Functions Coordinates and delivers high-quality, patient-centered care in accordance with organizational policies, protocols, and the nursing process. Conducts thorough patient assessments and documents findings accurately, reporting changes in condition to the appropriate care team members. Utilizes knowledge of human growth and development to provide age-appropriate care and education. Administers prescribed medications, monitors for side effects, and documents administration in accordance with standards of practice. Assists physicians during procedures within the scope of documented competency and skill level. Collaborates with the healthcare team to develop, implement, and evaluate individualized care plans based on patient assessments and needs. Responds to medical emergencies and participates in life-saving interventions, such as CPR and code team activities, as appropriate. Advocates for the rights and needs of patients, ensuring their voices are heard and respected in care planning and delivery. Provides patient and family education on medical conditions, treatment plans, and post-discharge care, ensuring understanding and adherence to instructions. Implements and adheres to infection control protocols to prevent the spread of healthcare-associated infections. Monitors and operates medical equipment (e.g., IV pumps, monitors, ventilators) as needed for patient care and safety. Promotes patient safety by adhering to National Patient Safety Goals and maintaining a clean, safe environment for patients and staff. Participates in audits, chart reviews, and compliance checks to ensure adherence to standards of practice and regulatory requirements. Demonstrates responsible decision-making in planning, delegating, and providing care based on patient needs and organizational policies. Documents patient care and education thoroughly and promptly in the medical record. Engages in professional development to maintain clinical competency and understanding of current nursing standards and regulations. Participates in performance improvement initiatives, including data collection and process development, to enhance patient outcomes and care delivery. Critical Care RN: Administers medications and other treatments as prescribed, including intravenous medications and therapies. Manages complex medical equipment, including ventilators, monitoring devices, and other life-support systems. Performs procedures such as inserting central lines, managing tracheostomies, and providing advanced cardiac life support. Emergency Services RN: Rapid Assessment and Triage: Evaluate patients' conditions quickly to determine the severity of their injuries or illnesses and prioritize care accordingly. Conducts emergency procedures such as intubation, wound care, and suturing. Implements interventions to stabilize patients, including administering medications, starting IV lines, and providing respiratory support. OR Services RN: Provides comprehensive care to patients before, during, and after surgery, including assessments, planning, and evaluation of nursing care. Scrubs in for surgeries, assisting the surgical team with instruments and supplies, and ensuring a sterile environment. Monitors patient vital signs, administers medications, and observes for changes in patient condition. Cardiac Surgery RN: Continuously assesses patients' condition, including vital signs, hemodynamic parameters, and ECG readings. Administers medications and IV drips, adjusting dosages based on the patient's condition. Proficient in operating and maintaining advanced life support equipment like ventilators, intra-aortic balloon pumps, and ECMO. After cardiac surgeries, monitors patients' recovery, manage chest tubes, pacing wires, and wound care. Endoscopy RN: Assesses patient needs, reviews medical history, explains procedures, obtains consent, and prepares the patient for procedure. Monitors patient vitals, administers medications, and assists the physician during procedure. Provides post-procedure care, monitors recovery, and educates patients about aftercare instructions. Ensures the endoscopy room is properly prepared, instruments are sterilized, and equipment is functioning correctly. Obstetrics/Labor and Delivery/Post Partum/Nursery RN: Educates patients about pregnancy, provides prenatal screenings, and prepares patients for labor and delivery. Assesses and monitors the new mother's physical recovery, including vital signs, postpartum hemorrhage, and potential complications like postpartum depression. Assists with epidurals and other pain management techniques during labor. Administers pain medication, induces labor, and manages other medication needs during labor and delivery. Assists during labor and delivery, monitors fetal well-being, administers medications, and provides pain relief. Monitors mothers and newborns after delivery, assessing their well-being, and providing education on postpartum care and breastfeeding. Assesses and monitors newborn health, taking vital signs, performing routine assessments, and educating parents on newborn care. Assists with gynecological exams and procedures, and provides education on reproductive health, contraception, and prenatal care. Educates patients about family planning, fertility, pregnancy, childbirth, and postpartum care. Interprets fetal heart rate patterns and assesses fetal well-being using electronic fetal monitoring. Oncology RN: Administers chemotherapy, manages side effects, monitors vitals, and manages pain. Explains treatments, answers questions, and provides information on resources. Provides emotional and psychological support to patients and their families. Orthopedics RN: Provides specialized care for patients with musculoskeletal conditions, injuries, and diseases. Provides care for Orthopedic patients encompassing pre-operative and post-operative care. Conducts peripheral/vascular assessments. Treats patients with immobilization devices. Provides pain management. Provides patient education. PACU RN: Assesses the patient's level of consciousness and responsiveness as they wake up from anesthesia. Evaluates pain levels and administers pain medications as prescribed. Observes any side effects of anesthesia, such as nausea, vomiting, shivering, or muscle aches. Monitors for and respond to any post-operative complications. Administers medications, including pain relievers and other post-operative medications, as prescribed. Regulates intravenous (IV) fluids and monitor fluid balance. Checks and changes dressings on surgical wounds. Ensures a clear airway and provide oxygen support as needed. Educates patients and families about post-surgery care, potential complications, and discharge instructions. NICU RN: Continuously assesses and monitors vital signs (heart rate, respiratory rate, blood pressure, oxygen saturation) and other signs of distress. Administers prescribed medications, intravenous fluids, and other treatments, including respiratory support and oxygen therapy. Manages feeding needs, including tube, breast milk feeding support, and ensuring adequate nutrition. Provides basic care tasks like diaper changes, bathing, and positioning. Performs procedures like inserting IV lines, administering medications, and assisting with intubation or ventilation. Operates and adjusts specialized medical equipment used in the NICU. Telemetry RN: Using telemetry equipment to track heart rhythms (EKG), blood pressure, oxygen saturation, and other vital signs. Analyzes telemetry data to identify trends, abnormalities, and potential problems, and reports these findings to physicians. Provides direct patient care, including medication administration, wound care, and patient education, with a focus on cardiac health. Recognizes and responds to emergencies, such as cardiac arrest, and implements appropriate interventions. Dialysis RN: Sets up and operates dialysis machines, monitors patients before, during, and after treatment, and adjusts treatment parameters as needed. Takes vital signs, monitors signs of complications, and responds to changes in patient condition. Educates patients and families about kidney disease, dialysis procedures, and the importance of adhering to treatment plans, diet, and medication. Inspects and maintains dialysis machines and equipment. Cath Lab RN: Pre-Procedure: Reviews medical history, assesses patient's overall health, and prepares them for the procedure. Intravenous (IV) Line Initiation: Starts and maintains an IV line for medication administration. Administers medications as prescribed by the physician. Educates patients and families about the procedure and what to expect. Verifies that surgical consents have been signed. During the Procedure: Assists the Cardiologist during the catheterization process. Closely monitors the patient's vital signs, hemodynamic data, and sedation levels. Ensures proper functioning of equipment and supplies. Manages potential complications and responding to emergencies. Post-Procedure: Continues to monitor the patient's vital signs and overall condition after the procedure. Administers post-procedure medications as needed. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Qualifications 0-2 years of experience in a clinical nursing role or student clinical rotations in an acute care setting required Knowledge, Skills and Abilities Strong knowledge of the nursing process and clinical nursing practices. Ability to perform thorough patient assessments and communicate findings effectively. Proficient in administering medications and monitoring for side effects. Effective communication and interpersonal skills to collaborate with interdisciplinary teams. Strong organizational skills and attention to detail in documenting patient care. Knowledge of safety standards, infection control, and quality improvement initiatives. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required BCLS - Basic Life Support required ACLS - Advanced Cardiac Life Support preferred PALS - Pediatric Advanced Life Support preferred NRP - Neonatal Resuscitation preferred Refer to facility or unit-specific guidelines for additional requirements.

Become a part of our caring community and help us put health first The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Use your skills to make an impact Required Qualifications Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action. MUST have Compact License Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. Comprehensive knowledge of Microsoft Word, Outlook and Excel Ability to work independently under general instructions and with a team Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications Education: BSN or Bachelor's degree in a related field Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. Experience as an MDS Coordinator or discharge planner in an acute care setting Previous experience in utilization management/utilization review for a health plan or acute care setting Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon Health Plan experience Previous Medicare/Medicaid Experience a plus Call center or triage experience Bilingual is a plus Additional Information Scheduled Weekly Hours: 40 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Work-At-Home Requirements Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required. Check your internet speed at ***************** A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients' homes. OneHome's patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

**$10,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS** 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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together** . In this position as a **Coding & Clinical Auditor / DRG Specialist RN** , you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. Employing both industry and Optum proprietary tools, you will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify overpayments. Utilizing excellent communications skills, you will compose rationales supporting your audit findings. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification + Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance + Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations and demonstrate working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments + Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing + Utilize solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment + Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics + Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly + Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements + Maintain and manage daily case review assignments, with a high emphasis on quality + Provide clinical support and expertise to the other investigative and analytical areas + Work in a high-volume production environment that is matrix driven **What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:** + Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Medical Plan options along with participation in a Health Spending Account or a Health Saving account + Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage + 401(k) Savings Plan, Employee Stock Purchase Plan + Education Reimbursement + Employee Discounts + Employee Assistance Program + Employee Referral Bonus Program + Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) + More information can be downloaded at: ************************* 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's Degree (or higher) + Unrestricted RN (Registered Nurse) license + CCS/CIC or willing to obtain certification within 6 months of hire + 3+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies + 2+ years of ICD-10-CM coding experience including but not limited to: expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM) + 2+ years of ICD-10-PCS coding experience including but not limited to: expert knowledge of the structural components of PCS such as selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers **Preferred Qualifications:** + Experience with prior DRG concurrent and/or retrospective overpayment identification audits + Experience with readmission reviews of claims + Experience with DRG encoder tools (ex. 3M) + Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry + Healthcare claims experience + Managed care experience + Knowledge of health insurance business, industry terminology, and regulatory guidelines **Soft Skills:** + Ability to use a Windows PC with the ability to utilize multiple applications at the same time + Demonstrate excellent written and verbal communication skills, solid analytical skills, and attention to detail + Ability to work independently in a remote environment and deliver exceptional results + Excellent time management and work prioritization skills **Physical Requirements and Work Environment:** + Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer + Have a secluded office area in which to perform job duties during the work day + Have reliable high - speed internet access and a work environment free from distractions *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. The salary range for this role is $34.42 to $67.60 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. **_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._ _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._ \#RPO #GREEN #RPOLinkedin

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Call Center Nurse RN is responsible for providing comprehensive clinical services to our customers located throughout the U.S. and may require multiple licenses to practice across various states. Services provided to our customers include but are not limited to the following telephonic services: clinical triage, transitions of care, medication adherence and reconciliation, management of gaps in care, and other care extension services. The Call Center Nurse assists and guides patients toward self-management and behavior modifications that result in improved patient outcomes. The Call Center Nurse is the primary point of contact for multiple disciplines. Success is measured in terms of improved patient outcomes, prevention of patient adverse events and satisfied customers, meeting or exceeding quality measures, producing consistent and high-quality work, and collaboration with other care team members. The Call Center Nurse is an experience nurse, able to perform tasks independently and once trained, without guidance. This person can provide education to patients, deploying best practices and standard workflow in their daily activities with the ability to apply their expertise across the various areas of responsibility, understanding how their interactions with patients affect customer satisfaction and can make recommendations to improve processes. Positions in this family require a current, unrestricted nursing license (RN) in the applicable state, as indicated in the function description and/or title. This is a PART TIME position working 7:30am - 6pm Eastern 2 days per week - either Mon and Friday OR Wednesday and Thursday. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Provide remote telephonic nursing support to patients, caregivers, and healthcare providers * Assess and triage patient calls to determine urgency of medical needs * Offer medical advice, guidance, and education to patients and caregivers regarding treatment plans, medication management, and self-care techniques * Collaborate with healthcare professionals to coordinate patient care and follow-up * Document patient interactions, assessments, and recommendations accurately and timely in electronic health records systems * Adhere to established protocols, guidelines, and best practices for telephonic nursing * Maintain patient confidentiality and privacy in accordance with HIPPA regulations * Participate in ongoing training and professional development activities to stay updated on medical advancements and best practices in telehealth * Contribute to quality improvement initiatives to enhance the delivery of telephonic nursing services * Provide exceptional customer service and support to ensure a positive experience for patients and clients * Ability to adapt nursing interventions and care plans to meet the individualized needs and preferences of diverse patients across the continuum of care * Demonstrates the ability to meet deadlines independently and efficiently, requiring minimal to no supervision * Actively engage in collaborative efforts within nursing team to ensure seamless communication, shared knowledge, and coordinated patient care delivery * Utilizes extensive expertise in chronic illnesses and medication management to effectively treat diseases * Works with supervisors to solve more complex problems 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: * Registered Nurse (RN) with a current, active, and unrestricted RN License in PA (state specific or compact) * 3+ years of clinical nursing experience * Experience with electronic medical records system(s) * Proven proficiency using MS Office Suite (i.e. Teams, Outlook, Word, Excel) * Ability to work PT hours (7:30am - 6PM EST) on either Monday and Friday OR Wednesday and Thursday Preferred Qualifications: * Telehealth nursing experience * Experience with Cerner * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, 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. 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.

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.** The Call Center Nurse RN is responsible for providing comprehensive clinical services to our customers located throughout the U.S. and may require multiple licenses to practice across various states. Services provided to our customers include but are not limited to the following telephonic services: clinical triage, transitions of care, medication adherence and reconciliation, management of gaps in care, and other care extension services. The Call Center Nurse assists and guides patients toward self-management and behavior modifications that result in improved patient outcomes. The Call Center Nurse is the primary point of contact for multiple disciplines. Success is measured in terms of improved patient outcomes, prevention of patient adverse events and satisfied customers, meeting or exceeding quality measures, producing consistent and high-quality work, and collaboration with other care team members. The Call Center Nurse is an experience nurse, able to perform tasks independently and once trained, without guidance. This person can provide education to patients, deploying best practices and standard workflow in their daily activities with the ability to apply their expertise across the various areas of responsibility, understanding how their interactions with patients affect customer satisfaction and can make recommendations to improve processes. Positions in this family require a current, unrestricted nursing license (RN) in the applicable state, as indicated in the function description and/or title. This is a PART TIME position working 7:30am - 6pm Eastern 2 days per week - either Mon and Friday OR Wednesday and Thursday. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Provide remote telephonic nursing support to patients, caregivers, and healthcare providers + Assess and triage patient calls to determine urgency of medical needs + Offer medical advice, guidance, and education to patients and caregivers regarding treatment plans, medication management, and self-care techniques + Collaborate with healthcare professionals to coordinate patient care and follow-up + Document patient interactions, assessments, and recommendations accurately and timely in electronic health records systems + Adhere to established protocols, guidelines, and best practices for telephonic nursing + Maintain patient confidentiality and privacy in accordance with HIPPA regulations + Participate in ongoing training and professional development activities to stay updated on medical advancements and best practices in telehealth + Contribute to quality improvement initiatives to enhance the delivery of telephonic nursing services + Provide exceptional customer service and support to ensure a positive experience for patients and clients + Ability to adapt nursing interventions and care plans to meet the individualized needs and preferences of diverse patients across the continuum of care + Demonstrates the ability to meet deadlines independently and efficiently, requiring minimal to no supervision + Actively engage in collaborative efforts within nursing team to ensure seamless communication, shared knowledge, and coordinated patient care delivery + Utilizes extensive expertise in chronic illnesses and medication management to effectively treat diseases + Works with supervisors to solve more complex problems 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:** + Registered Nurse (RN) with a current, active, and unrestricted RN License in PA (state specific or compact) + 3+ years of clinical nursing experience + Experience with electronic medical records system(s) + Proven proficiency using MS Office Suite (i.e. Teams, Outlook, Word, Excel) + Ability to work PT hours (7:30am - 6PM EST) on either Monday and Friday OR Wednesday and Thursday **Preferred Qualifications:** + Telehealth nursing experience + Experience with Cerner *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, 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._ _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._

**$10,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS** 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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together** . In this position as a **Coding & Clinical Auditor / DRG Specialist RN** , you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. Employing both industry and Optum proprietary tools, you will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify overpayments. Utilizing excellent communications skills, you will compose rationales supporting your audit findings. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification + Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance + Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations and demonstrate working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments + Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing + Utilize solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment + Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics + Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly + Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements + Maintain and manage daily case review assignments, with a high emphasis on quality + Provide clinical support and expertise to the other investigative and analytical areas + Work in a high-volume production environment that is matrix driven **What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:** + Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Medical Plan options along with participation in a Health Spending Account or a Health Saving account + Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage + 401(k) Savings Plan, Employee Stock Purchase Plan + Education Reimbursement + Employee Discounts + Employee Assistance Program + Employee Referral Bonus Program + Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) + More information can be downloaded at: ************************* 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's Degree (or higher) + Unrestricted RN (Registered Nurse) license + CCS/CIC or willing to obtain certification within 6 months of hire + 3+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies + 2+ years of ICD-10-CM coding experience including but not limited to: expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM) + 2+ years of ICD-10-PCS coding experience including but not limited to: expert knowledge of the structural components of PCS such as selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers **Preferred Qualifications:** + Experience with prior DRG concurrent and/or retrospective overpayment identification audits + Experience with readmission reviews of claims + Experience with DRG encoder tools (ex. 3M) + Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry + Healthcare claims experience + Managed care experience + Knowledge of health insurance business, industry terminology, and regulatory guidelines **Soft Skills:** + Ability to use a Windows PC with the ability to utilize multiple applications at the same time + Demonstrate excellent written and verbal communication skills, solid analytical skills, and attention to detail + Ability to work independently in a remote environment and deliver exceptional results + Excellent time management and work prioritization skills **Physical Requirements and Work Environment:** + Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer + Have a secluded office area in which to perform job duties during the work day + Have reliable high - speed internet access and a work environment free from distractions *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. The salary range for this role is $34.42 to $67.60 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. **_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._ _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._ \#RPO #GREEN #RPOLinkedin

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together This is a Field Based role with a Home-Based office. Must be open to traveling up to 50 miles from home office based on business need. If you are located in or within commutable driving distance from South Austin, TX, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities: * Assess, plan and implement care strategies that are individualized by patients and directed toward the most appropriate, at least restrictive level of care * Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services * Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members * Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: * Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays * Medical Plan options along with participation in a Health Spending Account or a Health Saving account * Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage * 401(k) Savings Plan, Employee Stock Purchase Plan * Education Reimbursement * Employee Discounts * Employee Assistance Program * Employee Referral Bonus Program * Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) * More information can be downloaded at: ************************* 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: * Current and unrestricted Registered Nurse license in the state of Texas * 2+ years of experience working within the community health setting or in a healthcare role * Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and ability to use multiple web applications * Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service * Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) * Valid driver's license, access to reliable transportation and the ability to travel in this 'assigned region' to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices * Reside in or within commutable driving distance from South Austin, TX Preferred Qualifications: * 1+ years of experience with long-term care services and support, Medicaid or Medicare * Knowledge of the principles of most integrated settings, including federal and State requirements like the federal home and community-based settings regulations * Proven ability to create, edit, save and send documents, spreadsheets and emails * Reside in South Austin, TX * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together** This is a Field Based role with a Home-Based office. Must be open to traveling up to 50 miles from home office based on business need. If you are located in or within commutable driving distance from South Austin, TX, you will have the flexibility to telecommute* as you take on some tough challenges. **Primary Responsibilities:** + Assess, plan and implement care strategies that are individualized by patients and directed toward the most appropriate, at least restrictive level of care + Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services + Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members + Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include: + Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays + Medical Plan options along with participation in a Health Spending Account or a Health Saving account + Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage + 401(k) Savings Plan, Employee Stock Purchase Plan + Education Reimbursement + Employee Discounts + Employee Assistance Program + Employee Referral Bonus Program + Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) + More information can be downloaded at: ************************* 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:** + Current and unrestricted Registered Nurse license in the state of Texas + 2+ years of experience working within the community health setting or in a healthcare role + Intermediate level of computer proficiency (including Microsoft Outlook, Teams) and ability to use multiple web applications + Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service + Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) + Valid driver's license, access to reliable transportation and the ability to travel in this 'assigned region' to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices + Reside in or within commutable driving distance from South Austin, TX **Preferred Qualifications:** + 1+ years of experience with long-term care services and support, Medicaid or Medicare + Knowledge of the principles of most integrated settings, including federal and State requirements like the federal home and community-based settings regulations + Proven ability to create, edit, save and send documents, spreadsheets and emails + Reside in South Austin, TX *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. _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._

Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As a Governmental Audit Reviewer, you are the expert who ensures clinical documentation stands up to scrutiny. You take the lead in auditing, submitting, and appealing records for home health, hospice, LTACHs, and community-based services. When external payers come calling-whether it's ADRs, CERTs, RACs, ZPICs, or other audits-you're ready. You dive into the details, respond with precision, and defend the integrity of care through every pre- and post-payment review. Your work protects reimbursement, supports compliance, and keeps the organization audit-ready at all times. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Reviews clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits (e.g., ADRs, RACs, CERTs, ZPICs) * Ensures consistency in clinical reviews through standardized processes and high inter-rater reliability * Drafts professional response letters and manages internal determinations for audit appeals * Coordinates and tracks appeal assignments, ensuring deadlines are met and documentation is prepared for Administrative Law Judge hearings * Maintains up-to-date knowledge of federal/state regulations, industry standards, and internal policies related to compliance and reimbursement * Collaborates across departments to minimize operational disruptions and communicate audit trends for corrective action * Supports the Governmental Audit Supervisor with repayment processes and additional compliance audits 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's degree in Nursing * Current and unrestricted licensure as a LPN * 1+ years of experience in hospice, LTACH, and/or home health care * Working knowledge of reimbursement and compliance regulations * Proficient in Microsoft Office applications (Word, Excel, etc.) Preferred Qualifications: * Bachelor's degree in Nursing * Experience in auditing and analyzing clinical documentation * Demonstrated leadership qualities * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. 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.

Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.** As a Governmental Audit Reviewer, you are the expert who ensures clinical documentation stands up to scrutiny. You take the lead in auditing, submitting, and appealing records for home health, hospice, LTACHs, and community-based services. When external payers come calling-whether it's ADRs, CERTs, RACs, ZPICs, or other audits-you're ready. You dive into the details, respond with precision, and defend the integrity of care through every pre- and post-payment review. Your work protects reimbursement, supports compliance, and keeps the organization audit-ready at all times. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Reviews clinical documentation for Home Health, Hospice, LTACHs, and Community-Based Services in response to governmental audits (e.g., ADRs, RACs, CERTs, ZPICs) + Ensures consistency in clinical reviews through standardized processes and high inter-rater reliability + Drafts professional response letters and manages internal determinations for audit appeals + Coordinates and tracks appeal assignments, ensuring deadlines are met and documentation is prepared for Administrative Law Judge hearings + Maintains up-to-date knowledge of federal/state regulations, industry standards, and internal policies related to compliance and reimbursement + Collaborates across departments to minimize operational disruptions and communicate audit trends for corrective action + Supports the Governmental Audit Supervisor with repayment processes and additional compliance audits 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's degree in Nursing + Current and unrestricted licensure as a LPN + 1+ years of experience in hospice, LTACH, and/or home health care + Working knowledge of reimbursement and compliance regulations + Proficient in Microsoft Office applications (Word, Excel, etc.) **Preferred Qualifications:** + Bachelor's degree in Nursing + Experience in auditing and analyzing clinical documentation + Demonstrated leadership qualities *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. **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._

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Schedule will be Monday through Friday from 8AM-5PM. Role does not require nights or Holidays however occasional weekend work may be required based off business needs. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * 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 * Participation 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 case 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 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: * Active, unrestricted RN license in state of residence * 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/AIR/ LTAC, Emergency Department, Urgent Care) * Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities * Demonstrated 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 Preferred Qualifications: * Bachelor's degree * Compact RN license * 2+ years case management experience * 1+ years Background that involves utilization review and evidence-based guidelines (InterQual Guidelines) * Managed care experience * Experience performing discharge planning * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, 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. 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.

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.** There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Can you feel it? Bring that energy to a role that helps us offer a higher level of care than you'll find anywhere else. Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As an Inpatient Care Management Nurse, you will be responsible for ensuring proper utilization of our health services. This means you will be tasked with assessing and interpreting member needs and identifying solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. **Schedule will be Monday through Friday from 8AM-5PM. Role does not require nights or Holidays however occasional weekend work may be required based off business needs.** You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + 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 + Participation 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 case 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 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:** + Active, unrestricted RN license in state of residence + 3+ years of clinical nursing experience practicing clinically (Acute Inpatient, SNF/AIR/ LTAC, Emergency Department, Urgent Care) + Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities + Demonstrated 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 **Preferred Qualifications:** + Bachelor's degree + Compact RN license + 2+ years case management experience + 1+ years Background that involves utilization review and evidence-based guidelines (InterQual Guidelines) + Managed care experience + Experience performing discharge planning *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy **California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only:** The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, 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._ _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._

Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Registered Nurse you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources. Primary Responsibilities: * Provide high-quality clinical services within scope of practice and infection control standards * Coordinate care with other members of the patient/client's care team from admission to discharge * Complete clinical nursing assessments per federal/state program requirements and payer needs * Ensure patient/client eligibility and medical necessity for services as defined by payer and agency policy * Develop and revise individualized plans of care/service plans with other community providers * Ensure plan of care frequency and duration meets patient needs and initiate revisions with physician approval 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: * Current and unrestricted RN licensure in the state of practice * Current driver's license, vehicle insurance and access to a dependable vehicle or public transportation * Current CPR certification * Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client Preferred Qualifications: * 1+ years of RN experience * Able to work independently * Good communication, writing, and organizational skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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.

Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources. Primary Responsibilities: * Clinical Competence * Initiates, develops, implements, and revises the plan of care in collaboration with the physician and other health care professionals * Supervises care provided by home health aides and licensed practical/vocational nurses, provides instruction, and assigns tasks according to State and federal regulations * Provides required supervisory visits * Documentation and Care Delivery * Provides high-quality clinical services within the scope of practice and infection control standards, in accordance with the plan of care, and in coordination with other health care team members * Completes comprehensive assessments (OASIS) including medication reconciliation accurately and timely * Documents patient visits per policy and payer requirements, and syncs timely per LHC policy * Quality * Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation * Communicates relevant information timely and effectively with appropriate agency staff, including patient care issues, visit assignments, schedule changes, orders, OASIS data sets, coding requests, and coordination with other clinicians * Communicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellence * Teamwork * Takes direction from Clinical Director and Executive Director professionally and completes assigned tasks timely, including required learning * Assists in the orientation of new agency personnel and serves as a preceptor to other staff and students * Actively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomes * Participates in on-call and weekend rotation as needed to meet patient needs * Adheres to and participates in the agency's utilization management model 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: * Current and unrestricted RN licensure in state of practice * 1+ years of Home Health experience * Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation * Current CPR Certification * Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client Preferred Qualifications: * Ability to work independently * Solid communication, writing, and organizational skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable 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.

Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Registered Nurse in Home Health you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources. Primary Responsibilities: * Clinical Competence * Initiates, develops, implements, and revises the plan of care in collaboration with the physician and other health care professionals * Supervises care provided by home health aides and licensed practical/vocational nurses, provides instruction, and assigns tasks according to State and federal regulations * Provides required supervisory visits * Documentation and Care Delivery * Provides high-quality clinical services within the scope of practice and infection control standards, in accordance with the plan of care, and in coordination with other health care team members * Completes comprehensive assessments (OASIS) including medication reconciliation accurately and timely * Documents patient visits per policy and payer requirements, and syncs timely per LHC policy * Quality * Makes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation * Communicates relevant information timely and effectively with appropriate agency staff, including patient care issues, visit assignments, schedule changes, orders, OASIS data sets, coding requests, and coordination with other clinicians * Communicates timely and effectively with physicians, patients, and family members to ensure quality care and service excellence * Teamwork * Takes direction from Clinical Director and Executive Director professionally and completes assigned tasks timely, including required learning * Assists in the orientation of new agency personnel and serves as a preceptor to other staff and students * Actively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomes * Participates in on-call and weekend rotation as needed to meet patient needs * Adheres to and participates in the agency's utilization management model 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: * Current and unrestricted RN licensure in state of practice * 1+ years of Home Health experience * Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation * Current CPR Certification * Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client Preferred Qualifications: * Ability to work independently * Solid communication, writing, and organizational skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable 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.