[Hiring] Utilization Management RN @UnitedHealth Group

Role Description

Position in this function is responsible for providing on-site transitional care coordination to ensure safe transitions of care and optimal communication between treating facility, Patient/Family and Atrius Health. Responsible for coordinating patient transitions from Hospital to home or other care settings, ensuring a smooth discharge process and continuity of care.

Position Details:

• Location: Remote (MA residents only)
• Department: Utilization Management
• Schedule: 40HRS Weekly M-F 8:00am- 4:30pm

If you are MA licensed RN, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Provides direct referral source servicing at identified facility, building and enriching relationships, identifying needs, problem solving and meeting or exceeding expectations of external customers.
• Serves as an extension of the Atrius Health practice site, connecting with Atrius Health patients and/or families to bridge the Atrius Health practice to the patient.
• Conducts review of the medical record for Atrius Health adult medical or surgical hospitalized patients.
• Conducts initial assessment of patient within 24 – 48 hours (business days of admission).
• Subsequent review/progress note at least every 7 days or accompanying a change in condition/plan.
• May provide educational and/or program material to the site facility staff in compliance with Atrius Health clinical initiatives, services and specialty programs.
• Performs needs assessments of patients/families for services including but not limited to primary care, specialty care visits, skilled homecare, palliative care, hospice care (including hospice residence), and/or skilled nursing facility, to ensure appropriateness of services and expedite transitions of care.
• Educates Atrius Health patients/families regarding provider relationships serviced through preferred homecare/SNF organizations.
• Assesses adult medical/surgical Atrius Health patients for risk of readmission, and communicates identified risks with transition of care, outpatient case manager and/or primary care team.
• Facilitates real-time review of contributing factors to readmission of patients and explores opportunities for acute care hospitalization (ACH) reduction.
• Accesses Atrius Health patient’s Epic medical record to determine current program enrollment for continuation of care.
• Assesses patients admitted with Heart Failure (HF) or Chronic Obstructive Pulmonary Disease (COPD) for HTM/RPM and initiates referral to the appropriate program.
• Initiates a referral to the Atrius health heart failure program when appropriate.
• Collaborates with hospital-based case manager to facilitate advance care planning documents such as health care proxy or MOLST form.
• Facilitates communication between patient’s hospital-based care team and practice based primary care team when needed or requested.
• Collaborates with transition of care team and hospital-based case manager to ensure post-hospital follow up visit is scheduled.
• Provides supportive patient/family education for targeted diagnoses including heart failure, diabetes, COPD to ensure optimal preparation for home discharge.
• Coordinates with the hospital-based case manager to facilitate regarding Atrius Health preferred provider networks.
• Seeks opportunities to improve communication and collaboration amongst all clinical partners in patient care treating facility and internal/external partners or provider.
• Collaborates and communicates with Manager and Atrius Health Case Manager to identify and address any issues or concerns.
• Documentation: Maintains accurate records of the discharge planning process in the patient's medical record for legal, regulatory, and billing purposes.
• Participates in service recovery as needed.
• Promotes problem identification, resolution to barriers in care delivery, efficiency, productivity and customer satisfaction.
• Builds relationships with physicians, referral sources, managed care and assigned facility(ies).
• Provides information, resource materials and education to all providers and case managers and solicits feedback.
• Promotes Atrius Health specialty programs designed to meet the needs of patients, providers, and partners.
• Assists with other referral source account coverage as needed.
• Performs other duties as requested.

Qualifications

• Graduate of a State-approved school of nursing.
• Current, unrestricted, license to practice professional nursing in the Commonwealth of Massachusetts.
• American Heart Association Basic Life Support (BLS).
• Electronic medical record (EMR) experience and/or aptitude to master the EMR based on other technology experience.
• Demonstrated proficiency using multiple software applications, including MS Office, EXCEL, Cloud based platforms and EPIC reporting workbench and dashboards.
• Demonstrated solid critical thinking, problem solving, interpersonal and patient interviewing skills.
• Demonstrated excellence in practice, documentation, and cost-effective care utilization. Maintains high patient satisfaction.
• Demonstrated ability to interpret clinical information, assess the implication of treatment and develop and implement a plan of care.
• Demonstrated ability to interpret clinical information, apply UM criteria and health plan guidelines for decision making.
• Demonstrated ability to work effectively in a faced paced team environment.

Requirements

• Able to use all electronic tools and applications relevant to the performance of the duties of the position, including but not limited to phone, keyboard, computer and computer applications.
• Able to work in multiple locations and cover multiple primary care practices as needed.
• Performs all job functions in compliance with applicable federal, state, local and company policies and procedures.
• Accesses only the minimum necessary protected health information (PHI) for the performance of job duties.
• Actively protects the confidentiality and privacy of all protected health information they access in all its forms (written, verbal, and electronic, etc) taking reasonable precautions to prohibit unauthorized access.
• Complies with all Atrius Health and departmental privacy policies, procedures and protocols.
• Follows HIPAA privacy guidelines without deviation when handling protected health information.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).