Optum
LVN Case Manager - ACO - Remote
Optum, Los Angeles, California, United States, 90079
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 to start
Caring. Connecting. Growing together.
Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.
Schedule : Monday - Friday; 8-5pm, or 10 - 630pm (rotation)Departments : Accountable Care Organization
Under the direction of a Registered Nurse, this position is responsible for ensuring the continuity of care in both the inpatient and outpatient settings utilizing the appropriate resources within the parameters of established contracts and patients' health plan benefits. Facilitates a continuum of patient care utilizing basic nursing knowledge, experience, and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site or telephonically as the need arises. Reports findings to the Care Management department Supervisor / Manager / Director in a timely manner.
If you are located in California, you will have the flexibility to work remotely* as you take on some tough challenges. Telecommuting is defined as a work arrangement in which the employee works outside the office, typically working from home, every day and may occasionally come into one of our facilities or client/customer sites for meetings, training, or events.
Primary Responsibilities:
Consistently exhibits behavior and communication skills demonstrating Optum's commitment to superior customer service, including quality, care, and concern with every internal and external customerImplements current policies and procedures set by the Care Management departmentConducts on-site or telephonic prospective, concurrent, and retrospective review of active patient care, including out-of-area and transplantReviews patients' clinical records of acute inpatient assignment within 24 hours of notificationReviews patients' clinical records within 48 hours of SNF admissionReviews patient referrals within the specified care management policy timeframe (Type and Timeline Policy)Coordinates treatment plans and discharge expectations. Discusses DPA and DNR status with the attending physician when applicablePrioritizes patient care needs. Meets with patients, patients' families, and caregivers as needed to discuss care and treatment planActs as patient care liaison and initiates discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement, or home health follow-upIdentifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings. Consults with the physician and other team members to ensure that the care plan is successfully implementedCoordinates provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of careAttends all assigned Care Management Committee meetings and reports on patient status as defined by the regionEnsures appropriate utilization of medical facilities and services within the parameters of the patient's benefits and/or CMC decisions. This includes appropriate and timely movement of patients through the various levels of careMaintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients, and familiesProvides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other related issuesInitiates data entry into IS systems of all patients within the parameters of Care Management policies and procedures. Maintains accurate and complete documentation of care rendered, including LOC, CPT code, ICD-9, referral type, date, etc.Follows patients on ambulatory care management programs, including CHF and home health, to optimize clinical outcomesUses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Required Qualifications:
Graduation from an accredited Licensed Vocational Nurse programCurrent LVN license in California1+ years of recent clinical experience working as an LVN/LPN
Preferred Qualifications:
2+ years of care management, utilization review or discharge planning experienceExperience in ACO "Accountable Care Organization"
California Residents Only:
The hourly range for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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: OptumCare is an 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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Caring. Connecting. Growing together.
Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.
Schedule : Monday - Friday; 8-5pm, or 10 - 630pm (rotation)Departments : Accountable Care Organization
Under the direction of a Registered Nurse, this position is responsible for ensuring the continuity of care in both the inpatient and outpatient settings utilizing the appropriate resources within the parameters of established contracts and patients' health plan benefits. Facilitates a continuum of patient care utilizing basic nursing knowledge, experience, and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site or telephonically as the need arises. Reports findings to the Care Management department Supervisor / Manager / Director in a timely manner.
If you are located in California, you will have the flexibility to work remotely* as you take on some tough challenges. Telecommuting is defined as a work arrangement in which the employee works outside the office, typically working from home, every day and may occasionally come into one of our facilities or client/customer sites for meetings, training, or events.
Primary Responsibilities:
Consistently exhibits behavior and communication skills demonstrating Optum's commitment to superior customer service, including quality, care, and concern with every internal and external customerImplements current policies and procedures set by the Care Management departmentConducts on-site or telephonic prospective, concurrent, and retrospective review of active patient care, including out-of-area and transplantReviews patients' clinical records of acute inpatient assignment within 24 hours of notificationReviews patients' clinical records within 48 hours of SNF admissionReviews patient referrals within the specified care management policy timeframe (Type and Timeline Policy)Coordinates treatment plans and discharge expectations. Discusses DPA and DNR status with the attending physician when applicablePrioritizes patient care needs. Meets with patients, patients' families, and caregivers as needed to discuss care and treatment planActs as patient care liaison and initiates discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement, or home health follow-upIdentifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings. Consults with the physician and other team members to ensure that the care plan is successfully implementedCoordinates provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of careAttends all assigned Care Management Committee meetings and reports on patient status as defined by the regionEnsures appropriate utilization of medical facilities and services within the parameters of the patient's benefits and/or CMC decisions. This includes appropriate and timely movement of patients through the various levels of careMaintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients, and familiesProvides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other related issuesInitiates data entry into IS systems of all patients within the parameters of Care Management policies and procedures. Maintains accurate and complete documentation of care rendered, including LOC, CPT code, ICD-9, referral type, date, etc.Follows patients on ambulatory care management programs, including CHF and home health, to optimize clinical outcomesUses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Required Qualifications:
Graduation from an accredited Licensed Vocational Nurse programCurrent LVN license in California1+ years of recent clinical experience working as an LVN/LPN
Preferred Qualifications:
2+ years of care management, utilization review or discharge planning experienceExperience in ACO "Accountable Care Organization"
California Residents Only:
The hourly range for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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: OptumCare is an 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
#J-18808-Ljbffr