Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced-based criteria within the documentation system Performs expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out of network facilities Interacts and effec... more details
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The ED RN Safe Discharge Nurse monitors real-time Admit, Discharge, Transfer (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care. Actively supports ED discharge follow-up care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate next site of care in collaboration with the hospitals/physician team and available outpatient ecosystem resources (PCP, specialist, in-home care, etc.).
If you are located within Pacific Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members
- Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced-based criteria within the documentation system
- Performs expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out of network facilities
- Interacts and effectively communicates with ED staff, members, and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information
- Identifies members ED discharge support opportunities level of risk by monitoring real-time ADT feeds and communicates with patient, ED, and outpatient teams for discharge coordination
- Conducts transition of care outreach following ED discharge to confirm access and completion of discharge plan
- Manages assigned case load in an efficient and effective manner utilizing time management skills
- Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities
- Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better monthly
- Adheres to organizational and departmental policies and procedures
- Takes on-call assignment as directed
- The ED Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicated
- Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines
- Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
- Refers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical bounds
- Monitors for any quality concerns regarding member care and reports as per policy and procedure
- Performs all other related duties as assigned
Youll 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:
- Current, unrestricted Multistate RN license
- Case Management Certification (CCM) or ability to obtain CCM within 2 years after the first year of employment
- 4+ years of diverse clinical experience
- 2+ years recent Emergency Department experience
- Knowledge of utilization management, quality improvement, and discharge planning
- Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
- Demonstrated ability to read, analyze and interpret information in medical records, and health plan documents
- Demonstrated ability to problem solve and identify community resources
- Proven ability to possess planning, organizing, conflict resolution, negotiating and interpersonal skills
- Proven ability to utilize critical thinking skills, nursing judgement, and decision-making skills
- Proven abilityto prioritize, plan, and handle multiple tasks/demands simultaneously
- Proven abilityto provide support24/7
Preferred Qualifications:
- Experience working with psychiatric and geriatric patient populations
- Experience with managed care and/or case management experience
Physical & Mental Requirements:
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment and/or machinery
- Ability to receive and comprehend instructions verbally and/or in writing
- Ability to use logical reasoning for simple and complex problem solving
*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy
California, Nevada or Washington 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, youll 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 everyoneof every race, gender, sexuality, age, location and incomedeserves 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: UnitedHealth Group 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.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
