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Posted: 26-Nov-24
Location: Redlands, California
Categories:
Internal Number: 144661160
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.
Optum’s 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.
Primary Responsibilities:
- Communicating with SNF’s and will be the primary contact person for any changes regarding members. Please document all conversation with the SNF staff
- Routinely doing on site visits expected 2 of visits expected each week, not just Care Conferences
- Nurses will document status of members rehab progress, 2 times per week in member’s authorization. Please use SNF team templates
- Nurse will document INITIAL “face to face” conversation with member and/or family; including expectation of rehab; measurable gains; and discharge plan (ready the family with known expectation of an anticipated d/c date/goal) to be done within 72 hours if documents available upon admission
- Nurses to document all in incoming and outgoing calls with family or patients
- Nurse is to close out case via discharge note to PCP, date and approved days. This is to be done within 48 hours of patient discharge
- Communicating with the Tech about all FAXs received
- Communicating with SNF-ist and facilities about member’s progress
- Communicating with manager and team members with any concerns about patient care
- If a member needs home health for a complex wound care or any non-routine please call to verify if they have staff to service member
- Nurse to clarify as needed type of Home Health services requested
- Nurse to input in the members authorization all denied days
- Attending weekly IPA SNF rounds and at SNF
- Nurse to clarify if member meets criteria for DME requests
- Refer patients to all PMNI programs according to the IPA
- Nurses are to approve all authorization for member with Criteria attached
- Nurse or Tech to complete PQI’s as needed
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:
- 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:
- 2+ years of care management, utilization review or discharge planning experience
- Experience in an HMO or experience in a Managed Care setting
California 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, 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: 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.
