Case Manager Optum Oveido

UnitedHealth Group•Oviedo, FL

About The Position

Optum FL is seeking a Case Manager to join our team in Oviedo, FL. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. Position in this function is responsible for ensuring the continuity of care in both the inpatient and outpatient 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. Works in conjunction with the care team and PCP as care team leader. Ensures evaluation is in alignment with site based goals.

Requirements

High school graduate, GED or equivalent
State Licensed LPN or RN
Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross) or be able to obtain within 90 days of employment
Certificate in Practical Nursing
Valid Florida LPN license
IV certification or the ability to obtain within 90 days of employment
Associates or Bachelor’s degree in Science
Valid Florida RN license

Nice To Haves

1+ years of experience in an acute clinical care setting
Care management, utilization review or discharge planning experience
HMO experience
Ability to read, write and speak the Spanish language fluently

Responsibilities

Prioritizes patient care needs upon initial visit and addresses emerging issues
Meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan as delineated in Transitions of Care program
Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings
Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes
Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care
Maintains effective communication with the physicians, disease management, hospitalists, extended care facilities, patients and families
Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports