Great Falls, Montana
Gainesville, Georgia
Gainesville, Georgia
New York, New York
Alexandria, Louisiana
Winder, Georgia
Posted: 11-Dec-24
Location: Las Vegas, Nevada
Categories:
Internal Number: 145116621
Optum NV is seeking a ER RN Case Manager to join our team in Las Vegas, NV. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.
At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
The ED RN Case Manager 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.).
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. 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 member’s 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 term
- 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
You’ll 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
- 4+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions
- 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 ability to prioritize, plan, and handle multiple tasks/demands simultaneously
- This department provides support 24/7
Preferred Qualifications:
- Experience working in the Emergency Department
- Experience with managed care and/or case management experience
Physical & Mental Requirements: (check all that apply)
- 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 Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. 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, you’ll 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.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
