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Care Management Professional
2 weeks ago
This role involves ensuring the continuity of care in both inpatient and outpatient settings, utilizing appropriate resources within established contracts and patient health plan benefits.
- Facilitates a continuum of patient care using basic nursing knowledge, experience, and skills to ensure appropriate utilization of resources and patient quality outcomes.
- Performs care management functions on-site or telephonically as needed.
- Reports findings to the Care Management department Supervisor/Manager/Director in a timely manner.
Key Responsibilities:
- Consistently exhibits behavior and communication skills demonstrating Optum's commitment to superior customer service.
- Implements current policies and procedures set by the Care Management department.
- Conducts on-site or telephonic prospective, concurrent, and retrospective review of active patient care, including out-of-area and transplant.
- Reviews patients' clinical records of acute inpatient assignment within 24 hours of notification.
- Coordinates treatment plans and discharge expectations.