Overview:
Responsible for providing 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. Delegates tasks as needed to professionals and para-professional employees. Coordinates activities and works closely with clinicians and staff to maintain efficient department functions and ensure successful operation of the department. Responsible for performing operational duties as required under the supervision of the site administrator or designee. Familiar with Model of Care and NCQA guidelines

Essential Functions:

• Prioritizes patient care needs upon initial visit and addresses emerging issues.

• Meets with telephonically with patients, patients' family and caregivers as needed to discuss care and treatment plan.

• Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings.

• Consults with physician and other team members to ensure that care plan is successfully implemented.

• Uses protocols and pathways in line with established disease management and care management programs in order to optimize clinical outcomes and minimize unnecessary institutional care.

• Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management.

• Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc. in order to maintain continuity of care.

• Works in coordination with the care team and demonstrates accountability with patient management and outcome.

• Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable.

• Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families.

• Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals.

• Participates actively in Monthly Care Management Department meetings and daily huddles.

• Documents pertinent patient information and Care Management Plan in Electronic Health Record.

• Coordinates care with central departments on assigned patient caseload, including, inpatient, long term care facilities, adult family homes, and home health agencies.

• Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports.

• Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions.

• Adheres to departmental policies and procedures. Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

• Participates in training all new care managers

Education:

• Minimum: Graduate from an accredited school of Nursing

• Minimum: Current State RN license.

• Minimum: Basic Life Support for Healthcare Providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)

• Preferred: Specialty certifications in CCMC

• Preferred: Bachelor’s degree in Nursing

• Preferred: AAACN

Experience:

• Minimum: 1-3 years of experience or equivalent experience.

• Preferred: 5 or more years of experience

Knowledge, Skills, and Abilities

• Computer literate.

• Ability to type 25 wpm.

• Basic Life Support for healthcare providers.

• Manual dexterity to use/handle equipment and instruments.

• Skilled in phlebotomy and I.V. therapy.

• Excellent verbal and written communication skills.

• Ability to concurrently perform multiple tasks.

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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. 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. Here you’ll find incredible ideas in one incredible company and a singular opportunity to do your life's best work.

Diversity creates a healthier atmosphere: Optum and its affiliated medical practices are Equal Employment Opportunity/Affirmative Action employers 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. Optum and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment