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RN, Care Manager
OVERVIEW OF POSITION:
Responsible for ensuring the continuity of care in the inpatient setting utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits. Facilitates continuum of patients’ care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site or telephonically as the need arises. Reports finding to the department management team in a timely manner.
Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer.
Conducts on-site or telephonic prospective, concurrent and retrospective review of active patient care, including out-of-area and transplant.
Consistently and accurately completes all required documentation including but not limited to timely completion of the LACE Assessment and long length of stay updates.
Consistently engages in huddles and interacts with Hospitalists / SNFist, Specialists, and medical directors to discuss care plan changes.
Identifies post discharge needs and meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan.
Collaborates with Hospitalists / SNFists to identify high-risk patients with complex medical and psych-social needs and those at risk for repeat admissions post discharge complications and refers to the appropriate programs.
Coordinates provisions for discharge including follow-up appointments, home health, social services, transportation in order to maintain continuity of care.
Provides excellent documentation of facilitation, coordination and collaboration to support TOC at discharge PDV, communication with patient, hand off of care, ACM tasking and sharing documentation between the care management system and the EHR.
Communicates authorization or denial of services to appropriate parties and may include patient (or agent), attending / referring physician or facility administration.
Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of appropriate reports such as Division of Financial Responsibility (DOFR) and Bed Days.
Ensures appropriate utilization of medical facilities and services within the parameters of the patients’ benefits and the patient’s clinical condition including appropriate and timely movement of patients through the various levels of care.
Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients and families.
Provides accurate information to patients and families regarding benefits, community resources, referrals and other related issues.
Demonstrates accountability and ownership of patient population assigned.
Seeks and identifies opportunities for process improvement.
Expected to participate in weekend and holiday coverage rotation per business needs.
Meets or exceeds productivity targets.
Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
Graduate from an accredited school of Nursing or equivalent experience.
Current California RN license.
Bachelor’s degree in Nursing preferred.
Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross).
2-3 years’ experience in a healthcare setting.
Previous care management or discharge planning experience.
HMO / Managed Care experience.
KNOWLEDGE, SKILLS, ABILITIES:
Ability to work with multiple computer platforms simultaneously.
Knowledge of current standards of patient care.
Thorough understanding of RN scope of practice.
Manual dexterity to use and handle equipment and instruments.
Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff.
Ability to make sound, independent judgments and act professionally under pressure.
Demonstrates effective documentation and verbal communication skills: factual, accurate, clear and timely to support delivery of effective patient care interventions and collaborative management.
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status
COVID-19 Work Location Requirement: You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.
Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.