RN Case Manager - Remote California

** Requisition number:
** 2368734

** Job category:
** Nursing

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.

Position in this function is responsible for providing professional nursing care by assessing, planning, implementing, and evaluating the care of patients under the supervision of a clinician or RN, Supervisor, or RN Charge Nurse. Delegates tasks as needed to professionals and para-professional employees. Coordinates activities and works closely with clinicians and staff to maintain efficient department functions and ensure the successful operation of the department.

Responsible for performing operational duties as required under the supervision of the site administrator or designee. Familiar with the Model of Care and NCQA guidelines.

You'll enjoy the flexibility to work remotely as you take on some tough challenges.

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* Schedule:

** Monday - Friday, 8:00 a.m.

- 4:30 p.m. PST

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* Primary Responsibilities:

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* + Prioritizes patient care needs upon initial visit and addresses emerging issues

+ Meets telephonically with patients, patients' families, and caregivers as needed to discuss care and treatment plan

+ 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

+ Uses protocols and pathways in line with established disease management and care management programs to optimize clinical outcomes and minimize unnecessary institutional care

+ Monitors and coaches patients using motivational interviewing techniques and behavioral change to maximize self-management

+ Oversees provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care

+ Works in coordination with the care team and demonstrates accountability with patient management and outcome

+ Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable

+ Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families

+ Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals

+ Participates actively in Monthly Care Management Department meetings and daily huddles

+ Documents pertinent patient information and Care Management Plan in Electronic Health Record

+ Coordinates care with central departments on assigned patient caseload, including inpatient, long-term care facilities, adult family homes, and home health agencies

+ Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports

+ Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions

+ Adheres to departmental policies and procedures. Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

+ Participates in training all new care managers

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.

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* Required Qualifications:

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* + Graduation from an accredited school of nursing

+ Active, unrestricted Registered Nurse license through the State of California AND state of residence

+ 1+ years of care management, utilization review or discharge planning experience

+ 1+ years of labor and delivery or obstetrical nursing experience (high-risk perinatal, antepartum)

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* Preferred Qualifications:

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* +…