RN Case Manager

$58,302 - $114,296/Yr

UnitedHealth Group - Redlands, CA

Full-time - Entry Level

Onsite - Redlands, CA

Insurance Carriers and Related Activities

About the position

The RN Case Manager position at Optum involves providing professional nursing care by assessing, planning, implementing, and evaluating patient care under the supervision of a clinician or RN supervisor. The role focuses on coordinating care for patients across various settings, ensuring continuity of care, and optimizing clinical outcomes through effective communication and collaboration with healthcare teams.

Responsibilities

• Prioritizes patient care needs upon initial visit and addresses emerging issues
• Meets telephonically with patients, patients' families, and caregivers as needed to discuss care and treatment plan
• Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings
• Consults with the physician and other team members to ensure that the care plan is successfully implemented
• Uses protocols and pathways in line with established disease management and care management programs to optimize clinical outcomes and minimize unnecessary institutional care
• Monitors and coaches patients using motivational interviewing techniques and behavioral change to maximize self-management
• Oversees provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
• Works in coordination with the care team and demonstrates accountability with patient management and outcome
• Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable
• Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families
• Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals
• Participates actively in Monthly Care Management Department meetings and daily huddles
• Documents pertinent patient information and Care Management Plan in Electronic Health Record
• Coordinates care with central departments on assigned patient caseload, including inpatient, long-term care facilities, adult family homes, and home health agencies
• Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports
• Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions
• Adheres to departmental policies and procedures. Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Participates in training all new care managers

Requirements

• Graduation from an accredited school of nursing
• Active, unrestricted Registered Nurse license through the State of California
• 1+ years of experience in a clinical setting or care management

Nice-to-haves

• Bachelor of Science in Nursing, BSN
• Telehealth certification
• 3+ years of experience working in acute care
• 1+ years of previous care management, utilization review or discharge planning experience
• HMO Experience

Benefits

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