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 Hospital Safe Discharge Case Manager initiates proactive outreaches to facility CM/UM/Discharge staff upon generating the daily census to manage discharges, working collaboratively with the facility discharging staff to assist in resolving any discharge barriers and continuing to engage facility staff until the actual discharge. *The schedule for this position is based on Eastern Standard Time Zones; required shifts are 8AM-5PM EST; subject to change depending on 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: • Assessing barriers to a safe and efficient discharge process, identifying the relevant resources, and finally coordinating and driving an efficient discharge process with both internal and external stakeholders • Demonstrates exemplary knowledge of acute inpatient case management, utilization management and care coordination processes as a foundation for transition planning activities • Manages assigned case load in an efficient and effective manner utilizing time management skills • Prepare and lead periodic rounds to discuss case needs, prioritize patients/discharges/issues/facilities and facilitate the member's transitions of care • Proficient in utilizing multiple electronic platforms, applications, and Electronic Medical Record (EMR) systems to coordinate patient care, document clinical information, and ensure accurate and timely communication among interdisciplinary teams • Confers with Medical Director or other leadership as appropriate for review of complex case situations • Working knowledge of skilled criteria for other levels of care; Skilled Nursing Facility, Acute Rehabilitation, and Home Health • Identifies and communicates a member's level of risk and participates in planning to mitigate those risks • Working closely with hospital staff, patients, families, and community services to promote a safe discharge plan and quality care • Communicates and supports hospital staff in facilitating member transition to other levels of post-acute care • Cultivate and build relationships, especially where one does not exist or is challenging, with hospitals and their personnel to build a collaborative discharge management relationship • Continuously look for opportunities to improve and streamline the discharge process, communicating with leadership innovative ideas and opportunities to optimize processes and outcomes • Collaborate closely with internal and external partners to aggressively drive safe discharges to achieve higher daily discharge volume and overall lower LOS • Use existing tools and communication platforms to support member transitions of care post discharge • Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better monthly • Adheres to organizational and departmental policies and procedures • Takes on-call assignment as directed • 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 • 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.
