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ED Case Manager (RN)

Company: UnitedHealth Group
Location: Louisville
Posted on: September 18, 2023

Job Description:

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. -
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We are currently seeking an Emergency Department Case Manager (RN) to join our team on a part-time basis that will consist of 8 hour shifts totaling 48 hours per bi-weekly pay period, including 1 weekend shift). -This is an onsite based role that will be part of a team that supports a deep strategic partnership between OptumInsight and Boulder Community Health, a nationally recognized, independent and community-focused health system that serves Boulder County, Colorado, and beyond. Boulder Community Health has a powerful vision - "partnering to create and care for the healthiest community in America" and Optum is proud to be one of the partners helping to advance that vision.

What we do: Optum provides managed services across a broad set of functions for Boulder Community Health - including case management, ambulatory care management, revenue cycle management, patient access (scheduling and registration), analytics, project management, and strategic transformation initiatives. Our aim is to enable Boulder Community Health to retain its independence as a community-focused health care provider, while providing access to the support and scale of Optum's people, processes, and technology. Come join us!

The Emergency Department Case Manager (RN) is responsible and accountable for coordination of patient services through an interdisciplinary process, which provides a clinical and psychosocial approach through the continuum of care. - Through concurrent case management, patients will be assessed to determine appropriateness of admission, continued hospitalization, as well as appropriate level of care. Discharge planning will begin at the time of (or prior to) admission, and reassessed ongoing throughout the course of hospitalization. - Quality and Risk Management issues will also be monitored for and reported as appropriate.

Primary Responsibilities:

Professional Accountabilities

Adheres to name badge/dress code compliance
Effectively problem-solves and actively pursues resolution
Directly communicates with staff, physicians, patients and families
Role models leadership behavior through courtesy, respect and efficiency
Coordinates patient care processes to achieve desired quality outcomes and identifies/controls inappropriate resource utilization
Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes. - Assures patient rights by offering a choice when appropriate
Reviews the patient plan of care with the multi-disciplinary team. - Facilitates and participates in multi-disciplinary team care conferences for patients with complex problems. - Communicates in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care
Daily communication and collaboration with the patient care staff to provide continuous assessment, evaluation and continuum planning to assure the patient receives the appropriate level of care at the appropriate time
Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity. - Arranges schedule to facilitate meeting with physicians for patient care rounds, team meetings and other opportunities to improve communication

  • Utilization Management

    • Knowledge of all applicable federal and state regulations. - Demonstrates a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care
    • Consults with physician section leaders for support in cases that continued stay is not appropriate, and case manager is unable to come to resolution by working with assigned physician
    • Responsible for communicating with the department director LOS and financial information, as well as issues that may affect the Continuum of Care process

      Continuum of Care Planning

      The CM will be responsible for integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases
      Educates patient/family as to options/choices within the level of care determined to be appropriate. - Initiates and insures completion of all necessary paperwork
      Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed
      Continuum of Care planning will emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists and case managers from contracted payors when appropriate to determine discharge plan that will be of maximum benefit to the patient. - Involve staff from next level of care in the treatment plan as early as possible to promote continuity and collaboration
      Reports all relevant information to the staff assuming responsibility in the next level of care
      Employees are expected to comply with all regulatory requirements, including CMS and Joint Commission Standards

      Risk Management

      Interface with department directors, Risk Management and patient representatives to identify potential QA or risk issues. Perform any necessary investigation, documentation and follow-up as required
      Participates in departmental SQI projects
      Ability to functionally coordinate and discharge plan for all age groups, including but not limited to the unborn child through geriatric age groups

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      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:

      Valid and unrestricted Registered Nurse (RN) license within the State of Colorado
      6+ months of experience in a healthcare or clinical setting
      Ability to work on a part-time basis (8 hour shifts totaling 48 hours per bi-weekly pay period, including 1 weekend shift) in our Boulder, CO facility
      Solid communication skills are necessary for meeting facilitation, educational presentations, team collaboration and patient interviews
      Solid analytical, critical thinking and organizational skills
      Knowledge/understanding of community resources, policies, and procedures

      Preferred Qualifications:

      Bachelor of Science in Nursing or Master's in Social Work
      Case Management Certification
      BLS Certification
      Clinical knowledge of the Labor and Delivery, Neonatal, Medical Surgical, Oncology, ICU patient and process

      Working Environment/Physical Activities:

      Normal visual acuity and hearing
      Ability to work with patients at various levels of care
      Ability to work with culturally diverse patients
      Ability to write, dictate, or otherwise communicate within diverse patient populations
      Ability to hear normal-level conversations and recall/record accurate information
      Operate within designated work area to include frequent communication over the telephone with patients, community resources and other health professionals
      Exposure to communicable diseases, toxic substances, ionizing radiation, medicinal and other conditions common to a clinic environment, including blood and body fluids
      Accomplishes tasks while working under pressure of deadlines

      Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges. -
      Colorado Residents Only: The salary range for Colorado residents is $56,300 to $110,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
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      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. - - - -
      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. -
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      UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. -

Keywords: UnitedHealth Group, Denver , ED Case Manager (RN), Executive , Louisville, Colorado

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