Hancock, Michigan
Banning, California
Jefferson City, Missouri, Missouri
Fairbanks, Alaska
Posted: 23-Nov-24
Location: Baltimore, Maryland
Categories:
Internal Number: 144632058
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.
Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN and LPN/LVN, depending on grade level, with current unrestricted licensure in applicable state. These roles identify, coordinate, or provide appropriate levels of care under the direct supervision of an RN or MD. Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for members. Includes Health Coach, Health Educator, and Health Advocate roles that require an RN.
- Generally work is self-directed and not prescribed
- Works with less structured, more complex issues
- Serves as a resource to others
- This job code should only be used for employees in this role with standard hours of 34 or less and a pay rate under the FLSA minimum for exempt roles
- All other employees in this role should be placed in the exempt version of this Job
Primary Responsibilities:
- Responsible for assessing barriers to a safe and efficient discharge process, identifying the relevant resources, and finally coordinating and driving an efficient discharge process with both internal and external stakeholders
- Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities
- Manages assigned case load in an efficient and effective manner utilizing time management skills
- Prepare and lead periodic rounds to discuss case needs, prioritize patients/discharges/issues/facilities and facilitate the member’s transitions of care
- Confers with Medical Director or other leadership as appropriate for review of complex case situations
- Working knowledge of skilled criteria for other levels of care; Skilled Nursing Facility, Acute Rehabilitation, and Home Health
- Identifies and communicates a member’s level of risk and participates in planning to mitigate those risks
- Working closely with patients, families, and community services to promote a safe discharge plan and quality care
- Communicates and supports hospital staff in facilitating member transition to other levels of post-acute care
- Cultivate and build relationships, especially where one does not exist or is challenging, with hospitals and their personnel to build a collaborative discharge management relationship
- Continuously look for opportunities to improve and streamline the discharge process, communicating with leadership innovative ideas and opportunities to optimize processes and outcomes
- Collaborate closely with internal and external partners to aggressively drive safe discharges to achieve higher daily discharge volume and overall lower LOS
- Uses existing tools and communication platforms to support member transitions of care post discharge
- 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
- 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
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:
- Bachelor of Science in Nursing
- Current, unrestricted RN license - Compact State License Required
- 5+ years of nursing experience in an acute care setting
- 2+ years of discharge planning experience
- Knowledge of utilization management and quality improvement
- Computer proficiency in Microsoft Office applications including Outlook, Word, and Excel
- Demonstrated ability to read, analyze and interpret information in medical records, and health plan documents
- Proven ability to utilize critical thinking skills, nursing judgement, and decision-making skills
- Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
- Proven ability to provide support 24/7
Preferred Qualifications:
- Case Management certification
- 1+ years of recent inpatient clinical documentation integrity (CDI) experience
- Experience working with psychiatric and geriatric patient populations
- Experience with managed care and/or case management experience
- Experience managing patients with SUD and/or Behavioral Health conditions
- Knowledge of InterQual/MCG Guidelines or other nationally recognized practice guidelines
- Knowledge of CMS coding guidelines and DRG assignment
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
Maryland 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.
At UnitedHealth Group, 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.
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.
