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Clinic Admin RN
2 months ago
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 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.
As a Registered Nurse, Care Manager, you will provide 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. You will delegate tasks as needed to professionals and para-professional employees. Coordinate activities and work closely with clinicians and staff to maintain efficient department functions and ensure the successful operation of the department. You will be responsible for performing operational duties as required under the supervision of the site administrator or designer. Lastly, you will need to be familiar with the Model of Care and NCQA guidelines.
Primary Responsibilities:
Prioritize patient care needs upon initial visit and address emerging issues
Meet telephonically with patients, families, and caregivers as needed to discuss care and treatment plans
Identify and assist with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, and custodial and ambulatory settings
Consult with the physician and other team members to ensure the care plan is successfully implemented
Use protocols and pathways aligned with established disease and care management programs to optimize clinical outcomes and minimize unnecessary institutional care
Monitor and coach patients using motivational interviewing techniques and behavioral change to maximize self-management
Oversee provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
Work in coordination with the care team and demonstrate accountability with patient management and outcome
Discuss Durable Power of Attorney (DPOA) and advanced directive status with the patient and PCP when applicable
Maintain effective communication with physicians, hospitalists, extended care facilities, patients, and families
Provide accurate information to patients and families regarding available resources through health plan benefits, community resources, and referrals
Participate actively in Monthly Care Management Department meetings and daily huddles
Document pertinent patient information and Care Management Plans in Electronic Health Records
Coordinate care with central departments on assigned patient caseload, including inpatient, long-term care facilities, adult family homes, and home health agencies
Demonstrate a thorough understanding of the cost consequences of Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports
Maintain concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions
Adhere to departmental policies and procedures
Use, protect, and disclose HCP patients' protected health information (PHI) only following Health Insurance Portability and Accountability Act (HIPAA) standards
Participate in training all new care managers
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:
Graduation from an accredited school of nursing
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
3+ years of experience working in acute care
1+ years of care management, utilization review or discharge planning experience
HMO experience
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