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Clinical Nurse Liaison, Reliant Medical Group
3 months ago
Reliant Medical Group, Part of Optum
Position Details:
- Department: Care Management - Discharge Case Management
- Location: Worcester, MA
- Hours: Full-time; Monday - Friday - 1-weekend rotation in 4 onsite at St. Vincent Hospital
- Conducts concurrent or retrospective utilization review applying approved utilization criteria for all inpatient admissions and/or observation services. Obtains appropriate authorizations from managed care organizations. Obtains clinical, functional and psychosocial information from the medical record and from the patient directly in a collaborative effort with other health care professionals, patient and/or family.
- Identifies, implements and continually reassesses the discharge plan. Collaborates with health care professionals to facilitate a safe, timely discharge from the inpatient setting which provides a positive outcome for patient. Uses evidence based assessment of most appropriate setting for discharge; engages skilled facility staff in clinical dialogue prior to discharge to a skilled nursing facility; assesses home care needs and arranges for appropriate services to meet those needs.
- Supports readmission reduction activities by ensuring an effective transition of care on discharge from the acute care facility. Identifies high risk patients; coordinates both the home visit program for Transitions in Care support; and the medication reconciliation for all patients not enrolled in the Transitions in Care program. Ensures that all clinically appropriate follow up appointments, tests, and home visits are scheduled prior to discharge with, at a minimum, a follow up appointment with the PCP within 5-7 days of discharge.
- Acts as a liaison between patients/families, Hospital; the organization; and the patient's Health Plan. Clarifies policies and procedures and patient benefits as needed. Authorizes services, coordinates care, and ensures timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate.
- Reviews cases with attending physician to ensure adherence to appropriate care paths and clinical guidelines; identifies opportunities to reduce gaps in care and improve adherence to appropriate guidelines; identifies facility opportunities for improved efficiencies; and refers cases to the Medical Director to assist in addressing resolution of these gaps in care or systemic issues.
- Documents all interventions and communications appropriately in the medical record and keeps records and submits reports as assigned by Manager.
- Identifies patients who would benefit from disease management, case management, or intensive case management services such as Home Run. Refers and enrolls these identified patients to the appropriate Care Management programs and/or other community services according to protocol. Engages patients prior to discharge in the identified program by sharing appropriate materials and setting expectations.
- Supports the wishes of those patients at the end of life including supporting adherence to MOLST orders; identifies patients who are candidates for MOLST orders and supporting the attending physician in educating the patient and their PCP in regards to that option; identifies and educates appropriate patients in regards to their hospice and palliative care benefits and supports their attending and/or PCP in enrollment into those programs for those patients who choose that benefit.
- Promotes the communication process between all team members, including the patient, family and all parties involved, to enhance collaboration and achieve optimal outcomes for the patient and the Plan.
- Participates in all applicable team meetings.
- Checks voicemail at regular intervals throughout the day and returns calls/messages within the same day of receipt.
- Supports department colleagues, covering and assuming changes in assignment as assigned by Manager.
Required Qualifications:
- Graduate from an accredited school of nursing
- Active, unrestricted licensure as a Registered Nurse in Massachusetts
- Current Massachusetts driver's license
- 3-5 years clinical experience as an RN
- Proficient in computer use, the Internet and health information technology
- Ability to travel frequently to hospitals, skilled nursing facilities, patient's homes and other sites where patients received care
- Certified in Case Management
- 1 year experience as a case manager in a payor or facility setting
- Disease Management or Care Coordination experience
- Excellent communication, interpersonal and organizational skills
Diversity creates a healthier atmosphere: OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
