RN, Care Manager
Company: Healthcare Partners
Location: Costa Mesa
Posted on: June 12, 2021
OVERVIEW OF POSITION:
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.
- Performs additional duties as assigned.
- You will be asked to perform this role in an office setting or
other company location, however, may be required to work from home
temporarily due to space limitations.
- Employees are required to screen for symptoms using a
UnitedHealth Group-approved symptom screener prior to entering the
work site each day, in order to keep our work sites safe. 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
- 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).
- 2-3 years' experience in a healthcare setting.
- Previous care management or discharge planning experience.
- HMO / Managed Care experience.
KNOWLEDGE, SKILLS, ABILITIES:
- Computer literate.
- Ability to work with multiple computer platforms
- Knowledge of current standards of patient care.
- Thorough understanding of RN scope of practice.
- Manual dexterity to use and handle equipment and
- 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
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
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: Healthcare Partners, Costa Mesa , RN, Care Manager, Other , Costa Mesa, California
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