Inpatient Case Mgr RN – CA

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

As a Registered Nurse, Care Manager, you will provide professional nursing care by assessing, planning, implementing, and evaluating the care of patients under the supervision of a clinician or RN, Supervisor, or RN Charge Nurse. You will delegate tasks as needed to professionals and para-professional employees. Coordinate activities and works closely with clinicians and staff to maintain efficient department functions and ensure the successful operation of the department. You will be responsible for performing operational duties as required under the supervision of the site administrator or designer. Lastly, you will need to be familiar with the Model of Care and NCQA guidelines.

This position follows a hybrid schedule with three in-office days per week.

Primary Responsibilities:

• Prioritize patient care needs upon initial visit and address emerging issues
• Meet telephonically with patients, families, and caregivers as needed to discuss care and treatment plans
• Identify and assist with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, and custodial and ambulatory settings
• Consult with the physician and other team members to ensure the care plan is successfully implemented
• Use protocols and pathways aligned with established disease and care management programs to optimize clinical outcomes and minimize unnecessary institutional care
• Monitor and coach patients using motivational interviewing techniques and behavioral change to maximize self-management
• Oversee provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
• Work in coordination with the care team and demonstrates accountability with patient management and outcome
• Discuss Durable Power of Attorney (DPOA) and advanced directive status with the patient and PCP when applicable
• Maintain effective communication with physicians, hospitalists, extended care faciliti.es, patients, and families
• Provide accurate information to patients and families regarding available resources through health plan benefits, community resources, and referrals
• Participate actively in Monthly Care Management Department meetings and daily huddles
• Document pertinent patient information and Care Management Plans in Electronic Health Records
• Coordinate care with central departments on assigned patient caseload, including inpatient, long-term care facilities, adult family homes, and home health agencies
• Demonstrate a thorough understanding of the cost consequences of Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports 
  Maintain concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions 
• Adhere to departmental policies and procedures 
• Use, protect, and disclose HCP patients’ protected health information (PHI) only following Health Insurance Portability and Accountability Act (HIPAA) standards 
• Participates in training all new care managers

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in

Required Qualifications:

• Graduation from an accredited school of nursing
• Active, unrestricted Registered Nurse license through the State of California
• 1+ years of experience in a clinical setting or care management

Preferred Qualifications:

• Bachelor of Science in Nursing, BSN
• Telehealth certification
• 3+ years of experience working in acute care
• 1+ years of care management, utilization review or discharge planning experience
• HMO Experience

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.