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Medical Behavioral Integration Nurse
4 weeks ago
Unlock the Future of Healthcare
At Optum, we're pushing the boundaries of basic care to create innovative health programs integrated across the entire continuum of care. As a Medical Behavioral Integration Nurse, you'll play a crucial role in this mission by collaborating with our Optum Care Management Team to plan, implement, coordinate, monitor, and evaluate options and services to meet the medical and behavioral health needs of our members.
Key Responsibilities:
- Screen and identify members with high-risk, long-term chronic conditions who will benefit from care management services, monitoring utilization as needed and referring cases from various sources.
- Perform member evaluations and onsite visits in multiple settings, including telephonic, member's homes, PCP/Specialists clinic, hospital, and skilled nursing facilities, providing feedback on planned interventions and outcomes of the plan of care.
- Conduct comprehensive assessments, identify, and assist members with high-risk symptoms/diagnoses and/or multiple co-morbidities who will benefit from intervention and engaging in care management services, collecting information from the patient, caregiver(s), healthcare providers, and other relevant parties as needed.
- Document findings and develop individualized care plans in a concise and comprehensive manner compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations.
- Utilize advanced clinical skills to make effective decisions to meet the member's health, behavioral health, and psychosocial needs, providing coaching, patient education, communication, and all available resources to promote quality and cost-effective outcomes.
- Document patient/family status, diagnosis, medications, treatment plan, goals, interventions, evaluation results, observations, and progress in electronic medical records/proprietary databases in a timely and accurate manner.
- Advocate for members and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team.
- Integrate a collaborative approach by attending interdisciplinary team meetings with nurses, physicians, and patient care coordinators regarding patient care as needed, collaborating with providers to determine acuity of behavioral health concerns and refer members to appropriate community resources.
- Utilize professional knowledge and critical thinking skills to facilitate MD consultation on complex and/or complicated cases.
- Apply Nursing/Counseling/Social Work theory, knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function.
- Manage assigned case load in an efficient and effective manner.
Requirements:
- Active and unrestricted licenses.
- 3+ years of RN experience in a hospital setting, acute care, direct care, or as a telephonic Case Manager for an insurance company.
- Proficient computer skills and good working knowledge of Microsoft Word.
- Proven ability to function independently and responsibly with minimal supervision.
- Proven ability to maintain direct and open communication with all levels of the organization.
- Proven ability to handle sensitive issues with members and providers in a confidential manner according to HIPAA guidelines.
- Proven ability and flexibility to assume responsibilities and tasks in a constantly changing work environment.
- Proven excellent customer service skills.
- Proven excellent interpersonal and problem-solving skills.
- Proven solid team player and team building skills.
- Proven demonstrates initiative in achieving individual, team, and organizational goals and objectives.
- Proven solid oral and written communication skills - specifically telephone skills.
- Willing or ability to travel locally up to 75% of the time.
Preferred Qualifications:
- BSN.
- Licensed RN with 3+ years of experience.
- Certified Case Manager (CCM).
- 3+ years of experience in a related mental health environment.
- Dual diagnosis experience with mental health and substance abuse.
- Experience working in an environment that required coordination of benefits and utilization of multiple groups and resources for patients.
- Experience working with low-income populations.
- Experience working with the aged, blind, or disabled.
- Clinical training experience.
- Managed Care experience.
- Case Management experience.
- Experience or exposure to discharge planning.
- Experience in utilization review, concurrent review, or risk management.
About Optum:
At Optum, 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.
Equal Employment Opportunity/Affirmative Action Employer:
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.
Drug-Free Workplace:
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
