LVN, Case Manager - CA Remote

UnitedHealth Group

  • El Segundo, CA
  • $20.00-35.72 per hour
  • Permanent
  • Full-time
  • 30 days ago
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. 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.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 Case Management department Supervisor / Manager / Director in a timely manner.If you are located in California, Pacific Standard Time (PST), you will have the flexibility to work remotely* as you take on some tough challenges.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 customer
  • Implements current policies and procedures set by the Case Management department
  • Conducts on-site or telephonic prospective, concurrent, and retrospective review of active patient care, including out-of-area and transplant
  • Reviews patients’ clinical records of acute inpatient assignment within 24 hours of notification
  • Reviews patients’ clinical records within 48 hours of SNF admission
  • Reviews patient referrals within the specified case management policy timeframe (Type and Timeline Policy)
  • Coordinates treatment plans and discharge expectations. Discusses DPA and DNR status with the attending physician when applicable
  • Prioritizes patient care needs. Meets with patients, patients’ families, and caregivers as needed to discuss care and treatment plan
  • Acts as patient care liaison and initiates pre-admission 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-up
  • Identifies 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 implemented
  • Coordinates provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
  • Communicates authorization or denial of services to appropriate parties. Communication may include patient (or agent), attending/referring physician, facility administration, and Optum claims as necessary
  • Attends all assigned Case Management Committee meetings and reports on patient status as defined by the region
  • Demonstrates a thorough understanding of the cost consequences resulting from case management decisions through the utilization of appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOR), and Bed Days
  • Ensures 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 care
  • Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients, and families
  • Provides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other related issues
  • Initiates data entry into IS systems of all patients within the parameters of Case 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 outcomes
  • Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
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.Required Qualifications:
  • Graduation from an accredited Licensed Vocational Nurse program
  • Current LVN license in California
  • 1+ years of recent clinical experience working as an LVN/LPN
Preferred Qualifications:
  • 3+ years of clinical experience working as an LVN/LPN
  • 2+ years of case management, utilization review or discharge planning experience
  • Experience in an HMO or experience in a Managed Care setting
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable.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.UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

UnitedHealth Group