RN Case Manager, Inpatient Services - Remote from a Compact State

Optum-posted about 1 year ago
Full-time • Mid Level
Remote • Irving, TX
10,001+ employees
Insurance Carriers and Related Activities
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The RN Case Manager for Inpatient Services at Optum is responsible for coordinating care for patients during their hospital stay and ensuring a smooth transition to lower levels of care. This role involves collaborating with interdisciplinary teams, conducting clinical reviews, and managing discharge planning to improve patient outcomes. The position allows for remote work flexibility for candidates located in Texas, emphasizing the importance of effective communication and clinical expertise in managing patient care.

  • Collaborate with the Interdisciplinary Care Team (ICT) to establish individualized transition plans for members.
  • Serve as the clinical liaison with hospital staff and perform clinical authorizations for inpatient care.
  • Conduct onsite or telephonic clinical reviews at various facilities.
  • Document medical necessity and appropriate levels of care using recognized clinical guidelines.
  • Communicate with facility staff, members, and families to assess discharge needs and formulate discharge plans.
  • Identify member risk levels using Population Stratification tools and communicate transition plans with the ICT.
  • Conduct transition discharge assessments to identify member needs at lower levels of care.
  • Manage assigned caseload efficiently using time management skills.
  • Demonstrate knowledge of utilization management and care coordination processes.
  • Confer with UM Medical Directors regarding inpatient cases and participate in department huddles.
  • Enter timely and accurate documentation into care management applications to meet audit requirements.
  • Adhere to organizational policies and procedures and take on-call assignments as directed.
  • Bachelor's degree in Nursing or Associate's degree in Nursing with 4+ years of experience.
  • Current, unrestricted RN license specific to the state of employment.
  • Case Management Certification (CCM) or ability to obtain within 12 months after the first year of employment.
  • 4+ years of diverse clinical experience with acutely ill patients.
  • Knowledge of Microsoft Office applications including Outlook, Word, and Excel.
  • Proven ability to read, analyze, and interpret medical records and health plan documents.
  • 3+ years of managed care and/or case management experience.
  • Experience with psychiatric and geriatric patient populations.
  • Knowledge of utilization management, quality improvement, and discharge planning.
  • Bilingual (English/Spanish) proficiency.
  • Proven problem-solving skills and ability to identify community resources.
  • Flexible work environment for remote work in Texas.
  • Opportunities for professional development and career growth.
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