RN Case Manager, Ambulatory Care
Posted on: January 10, 2022
OVERVIEW OF POSITION:Optumis seeking a full time ambulatory case
manager to support our case management team centralized in Arcadia,
CA.Primary work hours are Monday- Friday 8AM-5PM 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
- 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.EDUCATION:
- Bachelors degree from a four-year college and/or a professional
certification requiring formal education beyond a two-year
- Graduation from an accredited school of Nursing.
- California RN license.
- Bachelors degree in Nursing preferred.
- Basic Life Support for Healthcare providers (AHA) or CPR/AED
for the Professional Rescuer (American Red
- 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 drivers license, insurance and vehicle for
work-related travel.If you need to enter a work site for any
reason, you will be required to screen for symptoms using the
ProtectWell mobile app, Interactive Voice Response (i.e., entering
your symptoms via phone system) or a similar UnitedHealth
Group-approved symptom screener. 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 attained.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 youll 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 Case Manager, Ambulatory Care, Healthcare , Arcadia, California
Didn't find what you're looking for? Search again!