[Hiring] Case Manager @UnitedHealth Group

Role Description

The After Hours Care Manager - LPN provides inpatient care management services related to discharge planning/coordination; HLOC transfers; ED Diversion. The goal of this position is to enhance the quality of member management through collaboration with Physicians, facility representatives, and inpatient care coordinators. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance.

Work Hours: Available to work evenings, weekends, holidays. (1) Evening shift with 3 weekends on and 1 weekend off totaling 40 hrs per week, 3pm PST - 11:30pm PST and (1) Morning shift with 3 weekends on and 1 weekend off totaling 40 hrs per week, 8am PST - 4:30pm PST. If you are located in California, you will have the flexibility to work remotely as you take on some tough challenges.

• Performs job function telephonically
• Coordinates safe transfers, and discharge instructions as directed by the hospitalists and Care Management teams
• Delegates provisions for discharge including but not limited to follow-up appointments, home health, social services, transportation to care coordinators to ensure appropriate and timely movement of patients through the various levels of care
• Consistently and accurately completes required documentation
• Approves medically appropriate referrals within required regulatory timeframes to facilitate safe discharges or transfers
• Ensures appropriate utilization of medical facilities and services within the parameters of the patients’ benefits
• Maintains effective communication with the physicians, hospitals, extended care facilities, and when necessary, patients and families
• Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of Division of Financial Responsibility (DOFR)
• Communicates authorization or denial of services to appropriate parties and may include patient (or agent), attending/referring physician or facility administration
• Tracks team caseloads, completes staffing schedule, and escalates issues to management as needed
• Seeks and identifies opportunities for process improvement
• Expected to participate in weekend and holiday coverage rotation per business needs
• Maintains caseload per defined medical management department standards
• Meets or exceeds productivity targets
• Identifies patients appropriate for high-risk post discharge programs and refers accordingly
• Demonstrates ability to work independently and implement innovative approaches to complex member situations
• Performs additional duties as assigned

The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.

Qualifications

• Graduate of an accredited school of professional LVN/LPN nursing
• Current, active California LVN/LPN license
• 1+ years of experience in a health care setting

Requirements

• 3+ years of clinical experience working as an LVN/LPN (preferred)
• 2+ years of case management, utilization review or discharge planning experience (preferred)
• Experience in an HMO or experience in a Managed Care setting (preferred)

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment

Company Description

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. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.