Remote RN Case Manager ED Telecommute Compact Lics

Requisition Number: 2172024
Job Category: Nursing
Primary Location: San Antonio, TX
(Remote considered)

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life’s best work.(sm)

The ED RN Case Manager monitors real-time ‘Admit, Discharge, Transfer’ (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care. Actively supports ED discharge follow-up care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate next site of care in collaboration with the hospitals/physician team and available outpatient ecosystem resources (PCP, specialist, in-home care, etc.).

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have compact licenses and the ability to obtain other RN non-compact License.

Primary Responsibilities:

• Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members
• Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced-based criteria within the documentation system
• Performs expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out of network facilities
• Interacts and effectively communicates with ED staff, members, and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information
• Identifies member’s ED discharge support opportunities level of risk by monitoring real-time ADT feeds and communicates with patient, ED, and outpatient teams for discharge coordination
• Conducts transition of care outreach following ED discharge to confirm access and completion of discharge plan
• Manages assigned case load in an efficient and effective manner utilizing time management skills
• Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities
• Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better monthly
• Adheres to organizational and departmental policies and procedures
• Takes on-call assignment as directed
• The ED Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicated
• Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines
• Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
• Refers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical bounds
• Monitors for any quality concerns regarding member care and reports as per policy and procedure
• Performs all other related duties as assigned

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:

• Bachelor’s degree in Nursing and/or, Associate’s degree in Nursing combined with 4+ years of experience above the required years of experience
• Current, unrestricted RN license, specific to the state of employment
• Case Management Certification (CCM) or ability to obtain CCM within 2 years after the first year of employment
• 4+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions
• Knowledge of utilization management, quality improvement, and discharge planning
• Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
• Demonstrated ability to read, analyze and interpret information in medical records, and health plan documents
• Demonstrated ability to problem solve and identify community resources
• Proven ability to possess planning, organizing, conflict resolution, negotiating and interpersonal skills
• Proven ability to utilize critical thinking skills, nursing judgement, and decision-making skills
• Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
• This department provides support 24/7

Preferred Qualifications:

• Experience working in the Emergency Department
• Experience working with psychiatric and geriatric patient populations
• Experience with managed care and/or case management experience

Physical & Mental Requirements:

• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Careers at OptumCare. We’re on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we’re creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life’s best work.(sm) 

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $56,300 to $110,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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