RN, Care Manager
Posted on: November 22, 2020
OVERVIEW OF POSITION:Responsible for ensuring the continuity of
care in the outpatient setting utilizing the appropriate resources
within the parameters of established contracts and patients' health
plan benefits.-- Facilitates continuum of patients' care utilizing
advanced nursing knowledge, experience and skills to ensure
appropriate utilization of resources and patient quality
outcomes.-- Performs care management functions telephonically.
Ensures all care management activities are efficient, effective and
meet regulatory requirements. Reports finding to the department
management team in a timely manner.ESSENTIAL FUNCTIONS:
- Consistently exhibits behavior and communication skills that
demonstrate Optum's commitment to superior customer service,
including quality, care and concern with each and every internal
and external customer.
- Implements and monitors current medical group care management
programs within the policies and procedures set by the
- Reviews patient referrals within the specified care management
policy timeframe per Ambulatory Care Management Program
- Identifies and assists with the follow-up of selected patient
population in ambulatory settings.
- Consults with physician and other team members to ensure that
care plan is successfully implemented.
- Maintains effective communication with the health plans,
physicians, hospitals, extended care facilities, patients and
- Provides accurate information to patients and families
regarding HMO benefits, community resources, referrals and other
- Initiates and oversees data entry into IS systems of all
patients within the parameters of care management policies and
- Maintains timely, accurate and complete documentation of care
- Follows patients on ambulatory care management programs
- Maintains accuracy of list and program enrollment per
established guidelines and playbook
- Engages with appropriate members of the organization in a
professional, effective way.
- Demonstrates accountability and ownership of patient population
- Seeks and identifies opportunities for process
- Meets or exceeds productivity targets.
- Uses, protects, and discloses Optum patients' protected health
information (PHI) only in accordance with Health Insurance
Portability and Accountability Act (HIPAA) standards.
- Performs additional duties as assigned.EDUCATION:
- Graduate from an accredited school of Nursing.
- Current California RN license.
- Bachelor's degree in Nursing preferred.
- Basic Life Support for Healthcare providers (AHA) or CPR/AED
for the Professional Rescuer (American Red
- 2-3 years' experience in a healthcare setting.Preferred:
- Previous care management or discharge planning experience.
- HMO / Managed Care experience.KNOWLEDGE, SKILLS,
- Computer literate.
- Ability to work with multiple computer platforms
- Knowledge of current standards of patient care.
- Thorough understanding of RN scope of practice.
- Manual dexterity to use and handle equipment and
- Ability to effectively communicate and collaborate with
physicians, patients, families and ancillary staff.
- Ability to make sound, independent judgments and act
professionally under pressure.
- Demonstrates effective documentation and verbal communication
skills: factual, accurate, clear and timely to support delivery of
effective patient care interventions and collaborative
management.Careers with Optum. Here's the idea. We built an entire
organization around one giant objective; make health care work
better for everyone. Optum, part of the UnitedHealth Group family
of businesses, brings together some of the greatest minds and most
advanced ideas on where health care has to go in order to reach its
fullest potential. For you, that means working on high performance
teams against sophisticated challenges that matter. Here you'll
find incredible ideas in one incredible company and a singular
opportunity to do your life's best work. (SM)Diversity creates a
healthier atmosphere: Optum and its affiliated medical practices
are Equal Employment Opportunity/Affirmative Action employers and
all qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, age, national origin,
protected veteran status, disability status, sexual orientation,
gender identity or expression, marital status, genetic information,
or any other characteristic protected by law. Optum and its
affiliated medical practices is a drug-free workplace. Candidates
are required to pass a drug test before beginning employment.
Keywords: Optum, Arcadia , RN, Care Manager, Executive , Arcadia, California
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