RN, Care Manager
Location: Long Beach
Posted on: July 21, 2021
Responsible for ensuring the continuity of care in the inpatient
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 on-site or telephonically as the need
arises. Reports finding to the department management team in
a timely manner.
- 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.
- Conducts on-site or telephonic prospective, concurrent and
retrospective review of active patient care, including out-of-area
- Consistently and accurately completes all required
documentation including but not limited to timely completion of the
LACE Assessment and long length of stay updates.
- Consistently engages in huddles and interacts with Hospitalists
/ SNFist, Specialists, and medical directors to discuss care plan
- Identifies post discharge needs and meets with patients,
patients’ family and caregivers as needed to discuss care and
- Collaborates with Hospitalists / SNFists to identify high-risk
patients with complex medical and psych-social needs and those at
risk for repeat admissions post discharge complications and refers
to the appropriate programs.
- Coordinates provisions for discharge including follow-up
appointments, home health, social services, transportation in order
to maintain continuity of care.
- Provides excellent documentation of facilitation, coordination
and collaboration to support TOC at discharge PDV, communication
with patient, hand off of care, ACM tasking and sharing
documentation between the care management system and the EHR.
- Communicates authorization or denial of services to appropriate
parties and may include patient (or agent), attending / referring
physician or facility administration.
- Demonstrates a thorough understanding of the cost consequences
resulting from care management decisions through utilization of
appropriate reports such as Division of Financial Responsibility
(DOFR) and Bed Days.
- Ensures appropriate utilization of medical facilities and
services within the parameters of the patients’ benefits and the
patient’s clinical condition including appropriate and timely
movement of patients through the various levels of care.
- Maintains effective communication with the health plans,
physicians, hospitals, extended care facilities, patients and
- Provides accurate information to patients and families
regarding benefits, community resources, referrals and other
- Demonstrates accountability and ownership of patient population
- Seeks and identifies opportunities for process
- Expected to participate in weekend and holiday coverage
rotation per business needs.
- 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.
What's the first thing that happens when one of the
leading independent medical groups in the country comes together
with a global leader in health care? Opportunity.
With DaVita Medical Group, HealthCare Partners, The Everett
Clinic, Northwest Physicians Network, MountainView Medical
Group and Magan Medical Clinic
joining OptumCare and the UnitedHealth
Group family of companies, people like you will find
increasing levels of challenge, impact and professional success.
We're changing health care for the better by improving access to
affordable, high quality care, and working together to improve the
patient experience. That takes passion, commitment, intense focus
and the ability to contribute effectively in a highly collaborative
team environment. Are you with us? Learn more about this exciting
opportunity to do your life's best work.(SM)
Careers with OptumCare. Here's the
idea. We built an entire organization around one giant objective;
make the health system work better for everyone. So when it comes
to how we use the world's large accumulation of health - related
information, or guide health and lifestyle choices or manage
pharmacy benefits for millions, our first goal is to leap beyond
the status quo and uncover new ways to serve. OptumCare, 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
Diversity creates a healthier atmosphere: OptumCare 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. OptumCare and its affiliated
medical practices is a drug-free workplace. Candidates are required
to pass a drug test before beginning employment.
Keywords: Optum, Long Beach , RN, Care Manager, Other , Long Beach, California
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