RN Case Manager

1 month ago

Redlands, United States UnitedHealth Group Full time

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.

  • Schedule : Mon - Fri; 8-5pm

  • Department : inpatient Concurrently review

  • Locations : On site

Position in this function is 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 the successful operation of the department. Responsible for performing operational duties as required under the supervision of the site administrator or designee. Familiar with the Model of Care and NCQA guidelines.

Primary Responsibilities:

  • Prioritizes patient care needs upon initial visit and addresses emerging issues

  • Meets telephonically with patients, patients' families, 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 the physician and other team members to ensure that the care plan is successfully implemented

  • Uses protocols and pathways in line with established disease management and care management programs to optimize clinical outcomes and minimize unnecessary institutional care

  • Monitors and coaches patients using motivational interviewing techniques and behavioral change to maximize self-management

  • Oversees provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., 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 manager

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 Qualification:

  • Bachelor of Science in Nursing, BSN

  • Telehealth certification

  • 3+ years of experience working in acute care

  • 1+ years of previous care management, utilization review or discharge planning experience

  • HMO Experience

California Residents Only: The hourly range for this role 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: OptumCare 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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