RN Case Manager, Cardiology - Las Vegas, NV

Case Manager RN
- Cardiology

Optum NV is seeking a Case Manager RN
- Cardiology to join our team in Las Vegas, NV. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and erience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country.

Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Position in this function is responsible for the care management and coordination of all high risk high need patients assigned to a specific site, including both in and out patient clinical care. Assists clinicians in making informed decisions with these patients in order to promote better outcomes and smooth transitions of care. Follows the standards of Case Management and acts as the single point of contact for patients and families and providers.

Maintains records and data analysis related to high risk cases to report outcomes and ROI. Works collaboratively with all internal and external partners to ensure better clinical outcomes.

As the Complex RN Case Manager you will be responsible for care management and coordination of care for high risk cardiac and congestive heart failure patients. You would be working in the Cardiology department. You will be working closely with the Cardiology Providers, assisting with the CHF clinic, assisting with remote telemonitoring of patients and assist management/providers to set up other clinics/programs that are of interest.

The Complex RN Case Manager will have his/her own scheduled patients who come in for visits as well as those patients who will need to be reached telephonically.

• Apply case management standards of practice to focus on effective care of high risk high need patients at a specific site
• Serve as a patient advocate and resource and provide critical information and recommendations to the rest of the care team
• Participates in assessment activities to develop individualized plans of care in coordination with patient, family and providers
• Follows patient through various transitions of care to ensure that any gaps are identified and remedied, break down silos and promote efficient health care delivery
• Maintains strong knowledge of UM, Case management, community resources and plan benefits to ensure improved outcomes
• Works collaboratively with primary care on site staff to ensure patient compliance and adherence to medical plan of care
• Assist clinicians in implementing best practices for chronic care and disease management
• Follow standard protocols, processes and policies to include but not limited to the following:
  Medication Refill, Preventative Services, Managing Conditions, and Disease Case Management as signed by department head or designee
• Care management and coordinating care for our high risk Cardiology and CHF patients
• Knowledge of Milliman criteria and utilizing these criteria to manage CHF patients
• Participates in assessment activities to develop individualized plans of care with patients, family and Providers
• Provide patient education on disease processes to help promote self-management and compliance
• Responsible for maintaining an active caseload and provide interventions as needed within area of expertise and within their scope of practice
• Heart Failure disease management (telephonic and/or in person) will focus on adherence to lifestyle changes, symptoms recognition by patients, developing individualized treatment plans with patients and helping patients with the implementation of the treatment plan
• Responsible for ongoing monitoring of patients treatment plans, adherence, if goals are achieved and evaluation of care;
  Assisting in reducing readmission rates
• Exercise sound judgment (Critical Thinking Skills) in evaluating situations and making decisions; notify appropriate staff/providers in situations requiring assistance
• Make outbound telephone calls to patients to assess members' current health status.
• Provide telephonic nursing support to patients/caregivers related to disease process, signs and symptoms to report, telemonitoring, individual treatment plans, medications and for any additional concerns
• Responsible for monitoring and evaluation of electronic data received in the Telemonitoring Software Application from remote biometric monitors located in the patient's home
• Responsible for telephonic nursing assessment of biometric alerts, mission information and intervention accordingly…