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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.
The RN, Case Manager (Torrance, CA) 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
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
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.
Graduation from an accredited school of nursing
Active, unrestricted Registered Nurse license through the State of California
1+ years of experience in a clinical setting or care management
Bachelor of Science in Nursing, BSN
Specialty certifications in CCMC
5+ years of care management, utilization review or discharge planning experience
3+ years of experience working in acute care
California Residents Only: The hourly range for California residents is $27.07 to $53.08 per hour. 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.
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