Bariatric RN Case Manager
4 days ago
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. We are seeking a highly skilled and experienced Bariatric RN Case Manager to join our team. In this role, you will be responsible for clinical operations and medical management activities across the continuum of care for members seeking Bariatric surgery.
Key Responsibilities- Perform pre-service clinical coverage review of services that require notification, using applicable benefit plan documents, evidence-based medical policy and nationally recognized clinical guidelines and criteria.
- Determine medical appropriateness of services following evaluation of medical guidelines and benefit determination.
- Makes outbound calls to assess members' current health status.
- Case Manages members in the pre-operative and post-operative phases of Bariatric surgery to ensure a positive outcome.
- Identifies gaps or barriers in treatment plans and coordinate ongoing care with providers.
- Provides patient education to assist with self-management and healthy lifestyle changes.
- Stays connected with members to help them stay on the right track regarding diet and weight loss goals.
- Documents and tracks progress from initial assessment through post-operative care.
- Interacts with Medical Directors on challenging cases.
- Makes 'post operation' calls to ensure that discharged member receives the necessary services and resources.
- Prioritizes cases based on appropriate criteria (e.g., date of service, urgent, expedited).
- Ensures compliance with applicable federal/state requirements and mandates (e.g., turnaround times, medical necessity).
- Current, unrestricted RN license in your state of residence.
- Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses.
- 3+ years of experience in a hospital setting managing medical/surgical, ICU, bariatric patients, or complex case management.
- Intermediate level of proficiency with Microsoft Word, including the ability to navigate a Windows environment.
- Ability to work until 8:00pm at least one night per week.
- Access to high-speed internet from home (Broadband cable, DSL or Fiber).
- Designated workspace from home.
- Bachelor's Degree.
- Certified Case Manager (CCM).
- Compact/Multi-State RN license.
- Bariatric experience as the main focus of your job.
- Prior Authorization/Utilization Management/Review experience.
- Post-surgical experience.
- Patient education experience.
- Discharge planning experience.
- Case Management/Care Coordination experience.
- Managed care background.
- Knowledge of Milliman (MCG) or InterQual criteria.
- Reside in a compact license state with a compact license.
UnitedHealth Group is a global organization that delivers care, aided by technology to help millions of people live healthier lives. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. 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.
We are 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.
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