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Field Case Manager

3 months ago

Fort Worth, Texas, United States Optum Full time

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care.

We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs – helping patients access and navigate care anytime and anywhere.

As a team member of our naviHealth product, we help change the way health care is delivered from hospital to home supporting patients transitioning across care settings.

This life-changing work helps give older adults more days at home.

We're connecting care to create a seamless health journey for patients across care settings. The Skilled Inpatient Care Coordinator (SICC) plays an integral role in optimizing patients' recovery journeys.

The SICC completes weekly functional assessments and engages the PAC inter-disciplinary care team providing them with the proprietary nH Outcome tool to align expectations for discharge planning.

By serving as the link between patients and the appropriate health care personnel, the SICC is responsible for ensuring efficient, smooth, and prompt transitions of care.

At naviHealth, our mission is to work with extraordinarily talented people who are committed to making a positive and powerful impact on society by transforming health care.

naviHealth is the result of almost two decades of dedicated visionary leaders and innovative organizations challenging the status quo for care transition solutions.

We do health care differently and we are changing health care one patient at a time.

Moreover, have a genuine passion and energy to grow within an aggressive and fun environment, using the latest technologies in alignment with the company's technical vision and strategy.

Perform Skilled Nursing Facility (SNF) assessments on patients using clinical skills and appropriate measurement tools, such as nH Predict, nH Outcome, InterQual and CMS criteria, upon admission to SNF and periodically through the patient stays
Review targets for Length of Stay (LOS), target outcomes, and discharge plans with providers and families
Collaborate effectively with the patients' health care teams to establish an optimal discharge. The health care team includes physicians, referral coordinators, discharge planners, social workers, physical therapists, etc.
Manager or Medical Director
Assure appropriate referrals are made to the Health Plan, High-Risk Case Manager, and/or community-based services
Attend patient/family care conferences
When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forward to licensed physicians for review and issuance of the NOMNC when appropriate
Coordinate peer to peer reviews with naviHealth Medical Directors
Support new delegated contract start-up to ensure experienced staff work with new contract
Manage assigned caseload in an efficiently and effectively utilizing time management skills
Enter timely and accurate documentation into the CM Tool application
Daily review of census and identification of barriers to managing independent workload and ability to assist others
Adhere to organizational and departmental policies and procedures
Monday - Friday position.

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.

Proficient with Outlook, Excel and Word

2+ years of Case Management experience
~ Patient education background, rehabilitation, and/or home health nursing experience
~ Ability to establish a home office workspace
Ability to manipulate laptop computer (or similar hardware) between office and site settings
Ability to view screen and enter data into a laptop computer (or similar hardware) within a standard period of time
Ability to communicate with clients and team members including use of cellular phone or comparable communication device
Ability to mobilize to and within sites within an assigned local or regional market/area, including car transport, up to 85% of the t

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.

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 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.

UnitedHealth Group is a drug-free workplace.