The After Hours Care Manager - LPN. provides inpatient care management services related to discharge planning/coordination; HLOC transfers; ED Diversion. The goal of this position is to enhance the quality of member management, through collaboration with Physicians, facility representatives, and inpatient care coordinators. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance.
*Work Hours: Available to work weekends and holidays. Morning shift with 2 weekends on and 2 weekends off totaling 40 hrs per week, 8am PST - 4:30pm PST.
If you are located in California, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
- Performs job function telephonically
- Coordinates safe transfers, and discharge instructions as directed by the hospitalists and Care Management teams
- Delegates provisions for discharge including but not limited to follow-up appointments, home health, social services, transportation to care coordinators to ensure appropriate and timely movement of patients through the various levels of care
- Consistently and accurately completes required documentation
- Approves medically appropriate referrals within required regulatory timeframes to facilitate safe discharges or transfers
- Ensures appropriate utilization of medical facilities and services within the parameters of the patients' benefits
- Maintains effective communication with the physicians, hospitals, extended care facilities, and when necessary, patients and families
- Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of Division of Financial Responsibility (DOFR)
- Communicates authorization or denial of services to appropriate parties and may include patient (or agent), attending / referring physician or facility administration
- Track team caseloads, completes staffing schedule, and escalates issues to management as needed
- Seeks and identifies opportunities for process improvement
- Expected to participate in weekend and holiday coverage rotation per business needs
- Maintains caseload per defined medical management department standards
- Meets or exceeds productivity targets
- Identifies patients appropriate for high-risk post discharge programs and refers accordingly
- Demonstrates ability to work independently and implement innovative approaches to complex member situations
- Performs additional duties as assigned
The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.
Professional Competencies
- Consistently exhibits behavior that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer
- Ability to use written and oral communication skills
- 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
- Demonstrate knowledge of PC applications and other role supportive technology
- Ability to work with multiple computer platforms simultaneously
- Ability to analyze problems and formulate appropriate plans, solutions and courses of action
- Ability to work with frequent interruptions
- Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates
- Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners
- Ability to manage detail and work with accuracy
- Skill in working effectively under deadlines and changing priorities
- Ability to effectively delegate action items appropriately to non-clinical staff in accordance with their role and scope of practice
- Knowledge of current standards of patient care
- Thorough understanding of LPN scope of practice
Skills
- All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous, and respectful manner toward fellow employees, physicians and patients
- Must hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growth
- Performs all duties in a manner which promotes and supports the Core Values and Mission Statement
- Working knowledge of health care delivery systems
- Follows written and oral instructions and completes routine tasks independently
- Ensures confidentiality of patient information following HIPAA guidelines and company policies
- Attends/completes training to meet requirements of the job position and as needed or mandated by company policies and regulations
- Has regular and predictable attendance
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.
Required Qualifications
- Graduate of an accredited school of professional LVN/LPN nursing
- Current, active California LVN/LPN license
- 1+ years of experience in a health care setting
Preferred Qualifications
- 3+ years of clinical experience working as an LVN/LPN
- 2+ years of case management, utilization review or discharge planning experience
- Experience in an HMO or experience in a Managed Care setting
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20 - $36 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.