Case Manager RN

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

The Case Manager RN Responsible for providing professional nursing care by assessing, planning, implementing and evaluating the care of patients under the supervision of a clinician or RN, Supervisor, or RN Charge Nurse. Delegates tasks as needed to professionals and para-professional employees. Coordinates activities and works closely with clinicians and staff to maintain efficient department functions and ensure successful operation of the department. Responsible for performing operational duties as required under the supervision of the site administrator or designee. Familiar with Model of Care and NCQA guidelines

Primary Responsibilities:

• Prioritizes patient care needs upon initial visit and addresses emerging issues
• Meets with in person/telephonically with patients, patients' family and caregivers as needed to discuss care and treatment plan
• Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings
• Consults with physician and other team members to ensure that care plan is successfully implemented
• Uses protocols and pathways in line with established disease management and care management programs in order to optimize clinical outcomes and minimize unnecessary institutional care
• Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management
• Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc. in order to maintain continuity of care
• Works in coordination with the care team and demonstrates accountability with patient management and outcome
• Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable
• Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families
• Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals
• Participates actively in Monthly Care Management Department meetings and daily huddles
• Documents pertinent patient information and Care Management Plan in Electronic Health Record
• Coordinates care with central departments on assigned patient caseload, including, inpatient, long term care facilities, adult family homes, and home health agencies
• Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports
• Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions
• Adheres to departmental policies and procedures. Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Participates in training all new care managers

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.)
• More information can be downloaded at: >

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.

Required Qualifications:

• Associate's Degree in Nursing (or higher)
• Active, unrestricted Registered Nurse license through the State of California
• 1+ years of experience in a clinical setting or care management

Preferred Qualifications:

• Bachelor of Science in Nursing, BSN
• Specialty certifications in CCMC
• 5+ years of care management, utilization review or discharge planning experience
• 3+ years of experience working in acute care

California Residents Only: The hourly range for California residents is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer 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. Candidates are required to pass a drug test before beginning employment.

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