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Registered Nurse, Care Manager

Company: Optum
Location: West Covina
Posted on: April 30, 2021

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

What You’ll Do (aka Description):

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.

What Work Will Look Like:

  • 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.

What's required?

  • 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).
  • 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.

If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.

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.

Keywords: Optum, West Covina , Registered Nurse, Care Manager, Other , West Covina, California

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