Remote Discharge/Post – Acute Care Manager – ECS, KY

Optum

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Requisition Number: 2196496
Job Category: Nursing
Primary Location: Lexington, KY
(Remote considered)

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

The Integrated Care Team leverages a cross-functional approach, supporting the member end to end, with close collaboration and co-management. Generally, work is self-directed and not prescribed; is able to work with less structured and more complex issues.  The team will manage the full array of health care services, spanning both outpatient and Inpatient settings and with support from some specialized clinical teams.

This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification (PA), inpatient concurrent review (ICM), post-acute review (PACM), discharge planning (DCM), medical and behavioral care management and prevention to improve quality of care and patient outcomes.

Employees in this role will be cross trained on multiple roles (PA, ICM, PACM, DCM) to support fluctuating inventory within the Integrated Care Team. In this role you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: 

  • The Integrated Care Team leverages a cross-functional approach, supporting the member end to end, with close collaboration and co-management. Generally, work is self-directed and not prescribed; is able to work with less structured and more complex issues
  • The team will manage the full array of health care services, spanning both outpatient and Inpatient settings and with support from some specialized clinical teams. Serves as a resource to others
  • This new cross-functional collaboration provides an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review, post-acute review, discharge planning, medical and behavioral care management, and prevention to improve quality of care and patient outcomes. Candidates for this position would be required to support cross-training to multiple roles (PA, ICM, PACM, DCM) to support fluctuating inventory within the ICT
  • Perform initial and ongoing reviews pertaining to primary role (PA, ICM, DMC, PACM), appropriately applying clinical criteria (InterQual, policies, National and Local Coverage Determinations) for approval and sending to Medical Directors if review is necessary for determining an adverse determination.
  • Collaborate with Medical Directors, clinical peers, and Health Plan partners on performing appropriate clinical decision making and/or referrals
  • Apply clinical expertise when discussing case with internal and external Case Managers and Physicians
  • Follow all Standard Operating Procedures in end-to-end management of cases
  • Participate in team meetings, education discussions and related activities
  • Maintain compliance with Federal, State and accreditation organizations

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:

  • Current, unrestricted RN License
  • Nurse Licensure Compact (NLC)
  • State of Kentucky RN Licensure OR willingness to obtain RN license in Kentucky
  • 3+ years of experience as a Registered Nurse (RN) experience
  • Demonstrate a proficiency in computer skills – Windows, MS Suite (Word, Excel, Outlook), clinical platforms
  • Have a designated workspace and access to install secure high-speed internet via cable/fiber optic/DSL in home

Preferred Qualifications:

  • Bachelor’s Degree
  • Utilization Management/Utilization Review experience
  • Preservice Review/Prior Authorization experience
  • Experience in discharge planning and/or chart review
  • Familiarity with InterQual or MCG criteria guidelines
  • Familiarity with CMS guidelines/regulations
  • Familiarity with Medicaid guidelines/regulations

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.