RN, Utilization Management - Arcadia, CA
Posted on: January 14, 2021
OVERVIEW OF POSITION:Responsible for ensuring the continuity of
care in both the inpatient and 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 on-site or telephonically as the need arises.-- Works in
conjunction with the care team and PCP as care team leader.--
Ensures evaluation is in alignment with site based
- Schedule: full-time, Monday - Friday
- Specialty: UM/Referral Management
- UM experience highly preferred!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.
- Prioritizes patient care needs upon initial visit and addresses
- Meets with patients, patients' family 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
- Consults with physician and other team members to ensure that
care plan is successfully implemented.
- Coordinates treatment plans with the care team and triages
interventions appropriate to the skill set of the team
- Uses protocols and pathways in line with established disease
management and care management programs and approved by medical
management in order to optimize clinical outcomes.
- Monitors and coaches patients using techniques of motivational
interviewing and behavioral change to maximize
- Oversees provisions for discharge from facilities including
follow-up appointments, home health, social services,
transportation, etc., in order 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 PCP when applicable.
- Maintains effective communication with the physicians,
hospitalists, extended care facilities, patients and families.
- Provides accurate information to patients and families
regarding HMO benefits, community resources, referrals and other
- Participates actively in assigned Care Management Coordination
Committee (CMCC) meetings.
- Documents pertinent patient information and Care Management
Plan in Electronic Health Record and Care Management Systems as
- Coordinates care with central departments on assigned patient
caseload, including out-of-area, inpatient central and
- Demonstrates a thorough understanding of the cost consequences
resulting from Care Management decisions through utilization of
reports and systems such as Health Plan Benefits, Division of
Financial Responsibility (DOFR), utilization of metrics and CM
- Adheres to departmental policies and procedures as approved by
Office of the Medical Director (OMD) Quality Committee.
- Uses, protects, and discloses HCP patients' protected health
information (PHI) only in accordance with Health Insurance
Portability and Accountability Act (HIPAA) standards.
- Performs additional duties as assigned.REQUIREMENTS:
- Bachelor's degree from a four-year college and/or a
professional certification requiring formal education beyond a
- Graduation from an accredited school of Nursing.
- 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 Cross).
- You will be asked to perform this role in an office setting or
other company location, however, may be required to work from home
temporarily due to space limitations.
- Employees are required to screen for symptoms using a
UnitedHealth Group-approved symptom screener prior to entering the
work site each day, in order to keep our work sites safe. Employees
must comply with any state and local masking orders. In addition,
when in a UnitedHealth Group building, employees are expected to
wear a mask in areas where physical distancing cannot be
- Over 3 years and up to and including 5 years of experience in
clinical setting demonstrating the ability to assess, document and
implement the nursing care plan.
- Past clinical experience.Preferred:
- 3 to 5 years of acute nursing experience in critical care.
- Previous care management, utilization review or discharge
- HMO experience.KNOWLEDGE, SKILLS, ABILITIES:
- Computer literate.
- Ability to type 25 wpm.
- Knowledge of current standards of patient care.
- Thorough understanding of RN scope of practice.
- Manual dexterity to use/handle equipment and instruments.
- Ability to effectively communicate and collaborate with
physicians, patients, families and ancillary staff.
- Ability to make sound, independent judgments and act
professionally under pressure.
- Valid California driver's license, insurance and vehicle for
work-related travel.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
Keywords: Optum, Arcadia , RN, Utilization Management - Arcadia, CA, Executive , Arcadia, California
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