PathWays Critical Incidents Nurse - Indiana

Requisition Number: 2367098
UnitedHealth Group is a health care and well-being company that's dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together.
The PathWays Critical Incidents Nurse receives, triages, and investigates all Home and Community-Based Services (HCBS) critical incidents, including Abuse, Neglect, and Exploitation (ANE), and other reportable events, to ensure effective management of unusual occurrences in accordance with federal regulations and state rules.
Work Schedule: Monday through Friday 8:00 am to 5:00 pm. Willing to work on call weekend rotation approximately every 8 weeks.
If you reside within the state of Indiana, you will have the flexibility to telecommute* as you take on some tough challenges.
Potential for 5-10% of local travel.
Primary Responsibilities:

• Utilize clinical nursing judgment to assess reported incidents for immediate and long-term risk to member health, safety, and welfare
• Perform clinical triage of incidents to identify severity, urgency, and need for intervention
• Assess for indicators of abuse, neglect, or exploitation, including physical, psychological, and environmental signs
• Evaluate medical records, service plans, and clinical documentation to determine contributing factors and outcomes
• Identify gaps in care, medication concerns, or unmet clinical needs that may have contributed to the incident
• Recommend and coordinate immediate clinical interventions to ensure member stabilization and safety
• Conduct comprehensive investigations and ensure completion within thirty (30) days
• Collaborate with interdisciplinary teams (IDT) including nurses, case managers, social workers, and providers
• Ensure compliance with CMS, FSSA, and state HCBS waiver requirements, including clinical standards of care
• Participate in on-call support, including after-hours response for ANE and critical incidents

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.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:

• An active, unrestricted RN license in the state of Indiana
• 2+ years of experience in healthcare, managed care, clinical nursing, or case management
• 2+ years of experience in clinical assessment, care coordination, or utilization/quality review
• 1+ year of experience working with at least one of the following: APS, LTSS/LTC, Ombudsman
• 1+ year of experience with clinical documentation and medical record review
• Intermediate level of proficiency in Microsoft Office (Word, PowerPoint, Excel)
• Ability to travel 5%-10% of the time to conduct occasional in-person home or community visits
• Access to reliable transportation & valid US driver's license
• Reside in Indiana

Preferred Qualifications:

• Bachelor's degree or higher in Nursing (BSN)
• Experience in Managed Long-Term Services and Supports (MLTSS)
• Background in home health, long-term care, or community-based care settings
• Certification in case management (CCM), quality, or risk management
• Experience with clinical quality improvement methodologies (e.g., Six Sigma, Lean, SPC)
• Knowledge of healthcare delivery systems, claims, and regulatory frameworks
• 2+ years of experience in healthcare analytics, auditing, or quality oversight
• Ability to work in a high-paced environment with tight deadlines

Physical Requirements

• Ability to remain stationary for long periods of time to complete computer or tablet work duties

*All Telecommuters 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 rangefrom $29 to $52 annually 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.
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