Hybrid RN Case Manager Orlando FL

WellMed, part of the Optum family of businesses, is seeking a RN Case Manager to join our team in Orlando, 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. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. 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.

This  is a hybrid position that requires 2 days remote and  3 days a week in travel within the Orlando area.

Hours: Monday-Friday: 8am-5pm

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

Primary Responsibilities:

• Collaborates effectively with integrated care team (ICT) to establish an individualized plan of care for members. The interdisciplinary care team develops interventions to assist the member in meeting short and long term plan of care goals
• Serves as the clinical liaison with hospital, clinical and administrative staff as well as provides expertise for clinical authorizations for inpatient care. based on utilized evidenced-based criteria
• Performs concurrent and retrospective onsite or telephonic clinical reviews at the designated network or out of network facilities. Documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines
• Stratifies and/or validates patient level of risk and communicates during transition process with the Integrated Care Team
• Provide assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or member’s home. Develops interventions and processes to assist the member in meeting short and long term plan of care goals
• Manages assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process directly monitoring assigned members
• Demonstrates knowledge of utilization management and care coordination processes and current standards of care as a foundation for transition planning activities
• Confers with physician advisors on a regular basis regarding inpatient cases and participates in department case rounds. Plans member transitions, with providers, patient and family.
• With the assistance of the Managed Care/UM teams, guides physicians in their awareness of preferred contracts and providers and facilities
• Refers cases to Medical Director as appropriate for review or requests not meeting criteria or for complex case situations
• Participates in the development of appropriate QI processes, establishing and monitoring indicators

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we’re making health care work better for everyone.

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:

• Bachelor’s degree in Nursing, or Associate’s degree in Nursing and Bachelor’s degree in related field, or Associate’s degree in Nursing combined with 4+ of years of experience
• Current, unrestricted RN license required, specific to the state of employment
• Case Management Certification (CCM) or ability to obtain CCM within 6months after the first year of employment
• 5+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
• Proven knowledge of utilization management, quality improvement, discharge planning, and cost management
• Proficient with Microsoft Office applications including Word, Excel, and Power Point
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease

Preferred Qualifications:

• 2+ years of managed care and/or case management experience
• Experience working with geriatric patient population
• Bilingual (English / Spanish) language proficiency

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 salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

OptumCare 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.

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