LVN, After Hour Care Manager

$40,498 - $79,206/Yr

UnitedHealth Group - Redlands, CA

Full-time - Entry Level

Onsite - Redlands, CA

Insurance Carriers and Related Activities

About the position

The LVN, After Hour Care Manager position at Optum involves ensuring continuity of care for patients in both inpatient and outpatient settings. This role requires the utilization of nursing knowledge and skills to manage care effectively, particularly during after-hours and holidays. The manager will facilitate patient care, coordinate services, and communicate with various stakeholders to ensure quality outcomes and adherence to health plan benefits.

Responsibilities

• Exhibit superior customer service skills in all interactions with internal and external customers.
• Implement policies and procedures set by the Care Management department.
• Conduct telephonic reviews of active patient care and manage authorizations as per guidelines.
• Coordinate patient diversions from emergency departments to appropriate facilities or home health services.
• Act as a liaison for patient care and initiate discharge planning for high-risk patients.
• Respond to customer inquiries regarding patient admissions, discharges, or transfers.
• Manage outstanding emergent cases and issue necessary authorizations after hours.
• Communicate service authorizations or denials to relevant parties, including patients and healthcare providers.
• Attend Care Management Committee meetings and report on patient statuses.
• Understand cost implications of care management decisions and utilize relevant reports.
• Ensure appropriate utilization of medical services within patient benefit parameters.
• Maintain effective communication with health plans, physicians, and patients.
• Provide accurate information regarding health plan benefits and community resources.
• Initiate data entry for patient information in accordance with care management policies and maintain documentation.
• Protect and disclose patient information in compliance with HIPAA standards.

Requirements

• Graduation from an accredited Licensed Vocational Nurse program.
• Current LVN license in California.
• 1+ years of recent clinical experience as an LVN/LPN.

Nice-to-haves

• 2+ years of care management, utilization review, or discharge planning experience.
• Experience in an HMO or Managed Care setting.

Benefits

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