Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
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 goals.
Consistently exhibits behavior and communication skills that demonstrate the Company’s Mission Vision and Values, and commitment to superior customer service, including quality and care and concern with each and every internal and external customer
Represents the Company in a professional manner, following all Company policies and procedures
Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Ability to obtain CPR certification within 90 days of employment (Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)
Prioritizes patient care needs upon initial visit and addresses emerging issues
Meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan as delineated in Transitions of Care program
Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings
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 members
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 self-management
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, disease management, hospitalists, extended care facilities, patients and families
Provides accurate information to patients and families regarding plan benefits, community resources, referrals and other related issues
Documents pertinent patient information in Electronic Health Record and FOCUS as appropriate
Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports
Adheres to departmental policies and procedures as approved by Best Practice Committee and QMOC (Quality Medical Oversight Committee)
Ability to work collaboratively with the provider and care team to carry out nursing interventions under proper scope of practice
Performs additional duties as assigned
Ability to travel as necessary, or cover centers remotely, based on business need
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.
High school graduate or GED equivalent
Hold state required license and/or certification which allows placement of IVs OR must be willing to obtain within 90 days if required by state (e.g. RN License; LPN + IV Certification)
Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross) or be able to obtain within 90 days of employment
Active State of Florida licensure
Experience in an acute clinical care setting or equivalent
Care management, utilization review or discharge planning experience
1+ year experience in an acute clinical care setting
Bachelor’s degree in Nursing
Knowledge of current standards of patient care
Knowledge and skill in the applications of the techniques and practices of the nursing profession
Thorough understanding of RN scope of practice
Ability to provide on-site clinical treatment within scope of practice
Ability to perform accurate telephonic triages, accurately record findings with follow-up
Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff
Ability to be a clinical resource for non-licensed office staff
If the hired individual resides in Florida this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.
UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world’s large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. 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. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Care Manager, Health Care, US Healthcare, Coral Springs, Florida, FL