[Hiring] ED RN Case Manager @UnitedHealth Group

Role Description

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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

The RN Case Manager monitors real-time ‘Admit, Discharge, Transfer’ (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care. This position requires a candidate that can be flexible, adapting as the program grows to meet the needs of the populations and markets.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Must have compact licenses and the ability to obtain other RN non-compact License.

Primary Responsibilities:

• Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members.
• Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced-based criteria within the documentation system.
• Performs expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out of network facilities.
• Interacts and effectively communicates with ED staff, members, and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information.
• Identifies member’s ED discharge support opportunities level of risk by monitoring real-time ADT feeds and communicates with patient, ED, and outpatient teams for discharge coordination.
• Conducts transition of care outreach following ED discharge to confirm access and completion of discharge plan.
• Manages assigned case load in an efficient and effective manner utilizing time management skills.
• Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities.
• Enters timely and accurate documentation into designated applications to comply with documentation requirements and achieve audit scores of 90% or better monthly.
• Records required information into designated program tracker accurately and timely, ensuring proper KPI measurements, achieving audit scores of 90% or better monthly.
• Adheres to organizational and departmental policies and procedures.
• Takes on-call assignment as directed.
• The ED Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicated.
• Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines.
• Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms.
• Refers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical bounds.
• Monitors for any quality concerns regarding member care and reports as per policy and procedure.
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs all other related duties as assigned.

Qualifications

• Current, unrestricted Multistate RN license.
• 4+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions.
• 1+ years experience working in the Emergency Department.
• Knowledge of utilization management, quality improvement, and discharge planning.
• Rapid acuity-based clinical prioritization.
• Recognizing early signs of clinical deterioration.
• Identifying patients at risk for ED return visits or avoidable bounce-backs.
• Credibility with ED physicians and staff.
• Understanding ED workflow, throughput, and provider decision-making.

Preferred Qualifications

• Experience with managed care and/or case management experience.
• Understanding ED workflow, throughput, and provider decision-making.

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 $29 - $52 per hour based on full-time employment.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.