ER RN Case Manager Night Shift - Remote

Full-time - Mid Level

Remote - Las Vegas, NV

Insurance Carriers and Related Activities

About the position

The ER RN Case Manager at Optum NV plays a crucial role in enhancing patient care by managing transitions of care for patients discharged from the Emergency Department (ED). This position involves collaborating with various healthcare teams to ensure effective discharge planning and continuity of care, utilizing clinical guidelines and resources to support patients' health needs. The role emphasizes proactive outreach, coordination, and communication to optimize patient outcomes and improve healthcare delivery.

Responsibilities

• Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members.
• Serves as the clinical liaison with hospital, clinical and administrative staff, performing transition of care/care coordination for ED discharges using evidence-based criteria.
• Performs expedited, standard, concurrent, and retrospective clinical reviews at in-network and/or out-of-network facilities.
• Interacts and communicates effectively with ED staff, members, and their families to assess discharge needs and formulate discharge plans.
• Identifies member's ED discharge support opportunities and level of risk by monitoring real-time ADT feeds.
• Conducts transition of care outreach following ED discharge to confirm access and completion of discharge plans.
• Manages assigned case load efficiently utilizing time management skills.
• Demonstrates knowledge of utilization management and care coordination processes for transition planning activities.
• Enters timely and accurate documentation into designated care management applications to comply with documentation requirements.
• Adheres to organizational and departmental policies and procedures.
• Takes on-call assignments as directed.

Requirements

• 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.
• Proficient in Microsoft Office applications including Outlook, Word, and Excel.
• Ability to read, analyze, and interpret information in medical records and health plan documents.
• Demonstrated problem-solving skills and ability to identify community resources.
• Proven planning, organizing, conflict resolution, negotiating, and interpersonal skills.
• Ability to utilize critical thinking skills, nursing judgment, and decision-making skills.
• Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously.

Nice-to-haves

• Experience working in the Emergency Department.
• Experience with managed care and/or case management.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution