For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
OptumCare is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. OptumCare's focus is to do the right things for patients, physicians, and the community. OptumCare's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. The current focus of OptumCare is on seniors, and those with complex care needs, who most benefit from a high touch model of care.
Our Nurse Case Managers (NCM) are RNs who are responsible for the coordination of care for patients in the inpatient and community setting to determine medical appropriateness by following medical guidelines and benefit determination. The ultimate goal is to help the patient remain out of the hospital while remaining in a safe home with a quality of life.
The Nurse Case Manager acts as a longitudinal advocate for patients from the time the patient is admitted to the hospital until the patient with their care givers have returned to their home. They link the patient and care givers with the network of care team members to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence. The Nurse Case Manager is responsible for the case management activities across the continuum of care including coordination of care, development of a comprehensive care plan with any identified barriers, providing health education, coaching and treatment decision support for patients. The NCM participates in interdisciplinary conferences to review clinical assessments, update care plans and determine follow-up frequency with the team.
Complex Case Management for entire East Valley (North Phoenix, North Scottsdale, Paradise Valley, Tempe, Mesa, Gilbert, Chandler).
General Case Management for South East Valley (Mesa, Gilbert, Chandler, Queen Creek, Apache Junction, San Tan Valley).
Collaborates effectively with interdisciplinary team (IDT) to establish an individualized plan of care for members, goals including both short and long term
Works with the Utilization Management RNs, Social Worker (LMSWs) Case Managers and other internal and external providers to facilitate smooth care transitions
Serves as the primary clinical liaison with hospital, clinical and administrative staff for a smooth, seamless transition to the next level of care
Stratifies and / or validates patient level of risk and communicates during transition process with IDT
Ensures standardized execution of workflow processes, such as increase in admissions, monthly audits, and referral to Social Workers (LMSWs)
Provides 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 Medicare and Medicaid patients in meeting short and long term plan of care goals
Coordinates and attends member visits with PCP and specialists as needed
Works with their supervisor to work their assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process
Confers with physician advisors on a regular basis regarding inpatient cases and participates in departmental conferencing
Plans patient transitions with internal medical management staff and external providers
Attends and participates in interdisciplinary team meetings as directed
With the assistance of the UM team, guides physicians and hospital staff in their awareness of preferred contracts and providers as well as facilities
Enters timely and accurate data into designated case management applications as needed to communicate patient needs and maintains audit scores of 95% or greater on a monthly basis as well as to be determined patient satisfactory scores
Current, unrestricted RN license in the state of AZ
3 years of clinical experience in an acute care, home health, hospice, geriatric and / or hospital setting
Experience using EMR and CM practice guidelines
Knowledge of discharge planning alternatives options and interdisciplinary approaches
Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
Experience with Microsoft Office applications including Word
Independent problem identification / resolution and decision making skills
Able to prioritize, plan, and handle multiple tasks/demands simultaneously
Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area which includes but not limited to ( Field Base position)
Experience working with individuals with multiple co-morbidities and complex medical conditions
2 years of case management experience
Bilingual (English / Spanish) language proficiency
CCM certification or must obtain within 2 years of hire
Experience with Excel and Power Point
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: RN, BSN, Case Management, Case Manager, Complex Care, CCM, Accute Care, Home Health, Healthcare, Health Care, Registered Nurse, Phoenix, AZ, Chandler, Tempe, Gilbert, Arizona
Unitedhealth Group Inc.