About OptumCare
At OptumCare, we're redefining the way healthcare is delivered and experienced. As a clinician-led care organization, we're committed to making healthcare better for everyone. Our team of talented professionals is dedicated to advancing the health of our communities, and we're seeking a skilled ER RN Case Manager to join our team in Las Vegas, NV.
About the Role
We're looking for a highly motivated and experienced ER RN Case Manager to join our team on a night shift. As a member of our Optum Care Delivery team, you'll play a critical role in our vision to make healthcare better for everyone. In this role, you'll have the opportunity to work alongside talented peers in a collaborative environment that's guided by diversity and inclusion. You'll be empowered to live your best life at work and at home, and you'll have the chance to contribute to new practice ideas and initiatives that could help improve care for millions of patients across the country.
Key Responsibilities
- Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members
- 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 care management applications to comply with documentation requirements and achieve audit scores of 90% or better monthly
- Adheres to organizational and departmental policies and procedures
- Takes on-call assignment as directed
- Maintains current licensure to work in State of employment and maintains 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 term
- 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
- Performs all other related duties as assigned
Requirements
We're looking for a highly skilled and experienced ER RN Case Manager to join our team. To be considered for this role, you'll need to have:
- 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 possess 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
Preferred Qualifications
We're looking for a candidate with experience working in the Emergency Department and/or managed care and/or case management experience.
Work Environment and Culture
We're a remote-friendly organization, and this role will be working from home. You'll have the flexibility to work from anywhere within the U.S. and will be required to adhere to UnitedHealth Group's Telecommuter Policy. Our team is collaborative, diverse, and inclusive, and we're committed to making healthcare better for everyone.
Compensation and Benefits
We offer a competitive salary and a comprehensive benefits package, including a 401(k) contribution and equity stock purchase. We're an equal opportunity employer and welcome applications from diverse candidates.
Career Growth Opportunities and Learning Benefits
We're committed to helping our employees grow and develop their careers. As an ER RN Case Manager, you'll have the opportunity to work on challenging cases and develop your skills in utilization management, quality improvement, and discharge planning. You'll also have access to ongoing training and development opportunities to help you advance your career.
How to Apply
If you're a motivated and experienced ER RN Case Manager looking for a new challenge, we'd love to hear from you. Please apply to this role through our website, and we'll be in touch to discuss your application.
Equal Employment Opportunity
OptumCare is an Equal Employment Opportunity/Affirmative Action employer 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.
Application Deadline
This role will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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