Job Abstract

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

Optums Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Under the direction of a Registered Nurse, you will be responsible for ensuring the continuity of care in both the inpatient and outpatient settings utilizing the appropriate resources within the parameters of established contracts and patients health plan benefits. Facilitate a continuum of patient care utilizing basic nursing knowledge, experience, and skills to ensure appropriate utilization of resources and patient quality outcomes. Perform care management functions on-site or telephonically as the need arises. Lastly you will report the findings to the Care Management department Supervisor / Manager / Director in a timely manner.

Youll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Consistent exhibit behavior and communication skills demonstrating Optums commitment to superior customer service, including quality, care, and concern with every internal and external customer
• Implement current policies and procedures set by the Care Management department
• Conduct on-site or telephonic prospective, concurrent, and retrospective reviews of active patient care, including out-of-area and transplant
• Review patients clinical records of acute inpatient assignment within 24 hours of notification
• Review patients clinical records within 48 hours of SNF admission
• Review patient referrals within the specified care management policy timeframe (Type and Timeline Policy)
• Coordinate treatment plans and discharge expectations. Discusses DPA and DNR status with the attending physician when applicable
• Prioritize patient care needs. Meets with patients, patients families, and caregivers to discuss care and treatment plans
• Act as patient care liaison and initiate pre-admission discharge planning by screening for patients who are high-risk, fragile, or scheduled for procedures that may require caregiver assistance, placement, or home health follow-up
• 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 the physician and other team members to ensure the care plan is successfully implemented
• Coordinate provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
• Communicate authorization or denial of services to appropriate parties. Communication may include patient (or agent), attending/referring physician, facility administration, and Optum claims as necessary
• Attend all assigned Care Management Committee meetings and reports on patient status as defined by the region
• Demonstrate a thorough understanding of the cost consequences of care management decisions by utilizing appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOR), and Bed Days
• Ensure appropriate utilization of medical facilities and services within the patients benefits and/or CMC decisions. This includes appropriate and timely movement of patients through the various levels of care
• Maintain effective communication with health plans, physicians, hospitals, extended care facilities, patients, and families
• Provide accurate information to patients and families regarding health plan benefits, community resources, specialty referrals, and other related issues
• Initiate data entry into IS systems of all patients within the parameters of Care Management policies and procedures. Maintain accurate and complete documentation of care rendered, including LOC, CPT code, ICD-9, referral type, date, etc.
• Follow patients on ambulatory care management programs, including CHF and home health, to optimize clinical outcomes
• Use, protect, and disclose Optum patients protected health information (PHI) only following Health Insurance Portability and Accountability Act (HIPAA) standards

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:

• Graduation from an accredited Licensed Vocational Nurse program
• Current LVN license in California
• 1+ years of recent clinical experience working as an LVN/LPN

Preferred Qualifications:

• 3+ years of clinical experience working as an LVN/LPN
• 2+ years of care management, utilization review or discharge planning experience
• Experience in an HMO or experience in a Managed Care setting

*All employees working remotely will be required to adhere to UnitedHealth Groups Telecommuter Policy.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The hourly range for this role is $19.47 to $38.08 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.

Application Deadline:This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.