RN, Case Manager

5 days ago

Irvine, California, United States Optum Full time
Transforming Healthcare with Optum

At Optum, we're redefining healthcare by integrating programs across the entire continuum of care. If you're passionate about inventing the future of healthcare, this is your opportunity to make a meaningful impact.

About the Role

As a Registered Nurse, Care Manager, you'll play a vital role in assessing, planning, implementing, and evaluating patient care under the supervision of a clinician or RN. You'll work closely with clinicians and staff to maintain efficient department functions and ensure the successful operation of the department.

Key Responsibilities
  • Prioritize patient care needs upon initial visit and address emerging issues
  • Meet with patients, families, and caregivers 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 physicians 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 demonstrates 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
  • Participates in training all new care managers
Requirements
  • 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
  • Telehealth certification
  • 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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