Registered Nurse, Care Manager

Commerce, CA, United States

OVERVIEW OF POSITION: Responsible for ensuring the continuity of care in the outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits. Facilitates continuum of patients’ care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions telephonically. Ensures all care management activities are efficient, effective and meet regulatory requirements. Reports finding to the department management team in a timely manner. ESSENTIAL FUNCTIONS: Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer. Implements and monitors current medical group care management programs within the policies and procedures set by the department. Reviews patient referrals within the specified care management policy timeframe per Ambulatory Care Management Program playbooks. Identifies and assists with the follow-up of selected patient population in ambulatory settings. Consults with physician and other team members to ensure that care plan is successfully implemented. Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients and families. Provides accurate information to patients and families regarding HMO benefits, community resources, referrals and other related issues. Initiates and oversees data entry into IS systems of all patients within the parameters of care management policies and procedures. Maintains timely, accurate and complete documentation of care rendered. Follows patients on ambulatory care management programs Maintains accuracy of list and program enrollment per established guidelines and playbook Engages with appropriate members of the organization in a professional, effective way. Demonstrates accountability and ownership of patient population assigned. Seeks and identifies opportunities for process improvement. Meets or exceeds productivity targets. Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. Performs additional duties as assigned. EDUCATION: Graduate from an accredited school of Nursing. Current California RN license. Bachelor’s degree in Nursing preferred. Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross). EXPERIENCE: Minimum: 2-3 years’ experience in a healthcare setting. Preferred: Previous care management or discharge planning experience. HMO / Managed Care experience. KNOWLEDGE, SKILLS, ABILITIES: Computer literate. Ability to work with multiple computer platforms simultaneously. Knowledge of current standards of patient care. Thorough understanding of RN scope of practice. Manual dexterity to use and handle equipment and instruments. Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff. Ability to make sound, independent judgments and act professionally under pressure. Demonstrates effective documentation and verbal communication skills: factual, accurate, clear and timely to support delivery of effective patient care interventions and collaborative management. Full COVID-19 vaccination is an essential function of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain the necessary information from new hires prior to employment to ensure compliance. You will be expected to perform all essential functions of this role with or without reasonable accommodation. Failure to meet this requirement may result in the rescission of your offer or the termination of your employment. Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work. (SM) Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.