RN Case Manager, Inpatient Services - Remote from a Compact State

Job title: RN Case Manager, Inpatient Services - Remote from a Compact State in San Antonio, TX at UnitedHealth Group Company: UnitedHealth Group Job description: WellMed, part of the Optum family of businesses, is seeking a RN Case Manager, Inpatient Services to join our team in Texas. 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. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience 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.The Case Manager I- Inpatient Services performs onsite review or telephonic clinical review of inpatient admissions in an acute hospital, rehabilitation facility, LTAC or skilled nursing facility. Actively implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate lower level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The case manager is responsible for coordinating the care from admission through discharge. The Case Manager participates in integrated care team conferences to review clinical assessments, update care plans, identify members at risk for readmission and to finalize discharge plans.If you are located in Texas, you will have the flexibility to work remotely* as you take on some tough challenges.Primary Responsibilities:

• Collaborates effectively with integrated care team (ICT) to establish an individualized plan of care for members. The interdisciplinary care team develops interventions to assist the member in meeting short and long term plan of care goals
• Serves as the clinical liaison with hospital, clinical and administrative staff as well as provides expertise for clinical authorizations for inpatient care. based on utilized evidenced-based criteria
• Performs concurrent and retrospective onsite or telephonic clinical reviews at the designated network or out of network facilities. Documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines
• Interacts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs and formulate discharge plan and provide health plan benefit information
• Stratifies and/or validates patient level of risk and communicates during transition process with the Integrated Care Team
• Provide assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or member’s home. Develops interventions and processes to assist the member in meeting short and long term plan of care goals
• Manages assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process directly monitoring assigned members
• Provides constructive information to minimize problems and increase customer satisfaction
• Seeks ways to improve job efficiency and makes appropriate suggestions following the appropriate chain of command
• Demonstrates knowledge of utilization management and care coordination processes and current standards of care as a foundation for transition planning activities
• Confers with physician advisors on a regular basis regarding inpatient cases and participates in department case rounds. Plans member transitions, with providers, patient and family
• Enters timely and accurate data into designated care management applications as needed to communicate patient needs and maintains audit scores of 90% or better on a monthly/quarterly basis
• Adheres to organizational and departmental policies and procedures and credentialed compliance
• Takes on-call assignment as directed
• Attends and participates in integrated ca

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