RN Care Coordinator or Case Manager ED - Remote - PST or MST

UnitedHealth Group•Eden Prairie, MN

1d•$29 - $52•Remote

About The Position

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere. We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. The RN Case Manager monitors real-time ‘Admit, Discharge, Transfer’ (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care. Actively supports ED discharge follow-up care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate next site of care in collaboration with the hospitals/physician team and available outpatient ecosystem resources (PCP, specialist, in-home care, etc.). This position requires a candidate that can be flexible, adapting as the program grows to meet the needs of the populations and markets. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Must have compact licenses and the ability to obtain other RN non-compact License.

Requirements

Current, unrestricted Multistate RN license
4+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions
Knowledge of utilization management, quality improvement, and discharge planning
Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
Demonstrated ability to read, analyze and interpret information in medical records, and health plan documents
Demonstrated ability to problem solve and identify community resources
Proven ability to execute planning, organizing, conflict resolution, negotiating and interpersonal skills
Proven ability to utilize critical thinking skills, nursing judgement, and decision-making skills
Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
Ability to provide support 24/7

Nice To Haves

Experience working in the Emergency Department
Experience with managed care and/or case management experience

Responsibilities

Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members
Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced- based criteria within the documentation system
Performs expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out of network facilities
Interacts and effectively communicates with ED staff, members, and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information
Identifies member’s ED discharge support opportunities level of risk by monitoring real- time ADT feeds and communicates with patient, ED, and outpatient teams for discharge coordination
Conducts transition of care outreach following ED discharge to confirm access and completion of discharge plan
Manages assigned case load in an efficient and effective manner utilizing time management skills
Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities
Enters timely and accurate documentation into designated applications to comply with documentation requirements and achieve audit scores of 90%25 or better monthly
Records required information into designated program tracker accurately and timely, ensuring proper KPI measurements, achieving audit scores of 90%25 or better monthly
Adheres to organizational and departmental policies and procedures
Takes on-call assignment as directed
The ED Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicated
Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines
Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
Refers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical bounds
Monitors for any quality concerns regarding member care and reports as per policy and procedure
Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Performs all other related duties as assigned