For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together. The RN Case Manager monitors real-time 'Admit, Discharge, Transfer' (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care. Actively supports ED discharge follow-up care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate next site of care in collaboration with the hospitals/physician team and available outpatient ecosystem resources (PCP, specialist, in-home care, etc.). This position requires a candidate that can be flexible, adapting as the program grows to meet the needs of the populations and markets. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have compact licenses and the ability to obtain other RN non-compact License. Primary Responsibilities: • Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members • Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced- based criteria within the documentation system • Performs expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out of network facilities • Interacts and effectively communicates with ED staff, members, and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information • Identifies member's ED discharge support opportunities level of risk by monitoring real- time ADT feeds and communicates with patient, ED, and outpatient teams for discharge coordination • Conducts transition of care outreach following ED discharge to confirm access and completion of discharge plan • Manages assigned case load in an efficient and effective manner utilizing time management skills • Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities • Enters timely and accurate documentation into designated applications to comply with documentation requirements and achieve audit scores of 90% or better monthly • Records required information into designated program tracker accurately and timely, ensuring proper KPI measurements, achieving audit scores of 90% or better monthly • Adheres to organizational and departmental policies and procedures • Takes on-call assignment as directed • The ED Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicated • Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines • Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms • Refers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical bounds • Monitors for any quality concerns regarding member care and reports as per policy and procedure • Uses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards • Performs all other related duties as assigned 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.
Optum Home & Community Care is part of UnitedHealth Group and provides telephonic case management services to help members navigate the health care system and access support services. As an RN Case Manager, you would assess members' health status, identify gaps in treatment plans, establish care goals, coordinate with multidisciplinary teams including mental health clinicians, provide patient education and coaching, make referrals to community resources, and facilitate transitions between care settings—primarily through phone calls in a high-volume customer service environment.
