15 days old

Telephonic RN Case Manager – Deer Valley, AZ

Phoenix, AZ 85003
  • Job Code
    877439

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.

 

***This is a full time, Monday-Friday office-based/telephonic position located in Deer Park, AZ. Hours vary from 8:00am-5:00pm with some days working 11:00am-8:00pm. It has flexibility to telecommute on occasion.

 

Primary Responsibilities:

  • 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
  • Develops interventions and processes to assist Medicare, Medicaid and Commercial patients in meeting short and long term plan of care goals
  • Coordinates and attends member visits with PCP and specialists as needed
  • Nurse Case Managers work 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

 

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.

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Posted: 2020-06-18 Expires: 2020-07-18

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Telephonic RN Case Manager – Deer Valley, AZ

UnitedHealth Group
Phoenix, AZ 85003

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