OVERVIEW OF POSITION:
Under the direction of a registered nurse, this position is
responsible for after hours, weekends and holiday telephonic care
management in conjunction with other PSC nursing duties as assigned
for all five regions within Optum. Will ensure 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 basic nursing knowledge, experience and
Optum’s guidelines to ensure appropriate utilization of resources
and patient quality outcomes. Reports findings to the Care
Management department and PSC nurses by utilizing Patient Support
Center email address in a timely manner.
Schedule: per diem, needed for weekend/holiday coverage
Possibility of remote work with training in Torrance, CA
Care Management experience preferred
Consistently exhibits behavior and communication skills that
demonstrate Optum’s commitment to superior customer service,
including quality, care and concern with each and every internal
and external customer.
Provides after-hours support to Hospitalist in the coordination
of care from out of area to core facilities (non contracted
facilities to contracted facilities)
Implements current policies and procedures set by the Care
Reviews patient referrals within the specified care management
policy timeframe (Type and Timeline Policy).
Coordinates treatment plans and discharge expectations and
discusses DPA and DNR status with attending physician when
Prioritizes patient care needs and telephonically discusses
treatment plans with patients and appropriate representatives of
the Optum patient.
Identifies and assists with the follow-up of high-risk patients
in acute care settings, skilled nursing facilities, custodial and
Consults with physician and other team members to ensure that
care plan is successfully implemented.
Coordinates provisions for discharge from facilities including
follow-up appointments, home health, social services,
transportation, etc., in order to maintain continuity of care.
Communicates authorization or denial of services to appropriate
parties which may include patient (or agent), attending/referring
physician, facility administration and Optum claims as
Attends all PSC meetings.
Demonstrates a thorough understanding of the cost consequences
resulting from care management decisions through utilization of
appropriate reports such as Health Plan Eligibility and Benefits,
Division of Responsibility (DOR), and Bed Days.
Provides accurate information to patients and families regarding
health plan benefits, community resources, specialty referrals and
other related issues.
Uses, protects, and discloses Optum patients’ protected health
information (PHI) only in accordance with Health Insurance
Portability and Accountability Act (HIPAA) standards.
Performs additional duties as assigned.
1 or 2 years of post-high school education or a degree from a
Graduation from an accredited school of Nursing.
Current California LVN license.
Basic Life Support for Healthcare providers (AHA) or CPR/AED for
the Professional Rescuer (American Red Cross).
Over 1 year and up to and including 3 years of clinical
At least 1 year of recent clinical experience.
3 to 5 years of recent clinical nursing experience.
Previous care management, utilization review or discharge
Managed care experience.
KNOWLEDGE, SKILLS, ABILITIES:
Knowledge of current standards of patient care.
Thorough understanding of LVN scope of practice.
Manual dexterity to use/handle equipment and instruments.
Ability to effectively communicate and collaborate with
physicians, patients, families and ancillary staff.
Ability to make sound, independent judgments and act
professionally under pressure.
Careers with Optum. Here's the idea. We built an entire
organization around one giant objective; make health care work
better for everyone. 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. Here you’ll
find incredible ideas in one incredible company and a singular
opportunity to do your life's best work.(SM)
Diversity creates a healthier atmosphere: Optum and its
affiliated medical practices are Equal Employment
Opportunity/Affirmative Action employers 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. Optum and its affiliated
medical practices is a drug-free workplace. Candidates are required
to pass a drug test before beginning employment.