LVN, Utilization Management, Per Diem, Torrance
Posted on: July 19, 2021
OVERVIEW OF POSITION:
Under the direction of a registered Nurse, this position is
responsible for 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 basic 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. Reports findings to the
Care Management department Supervisor / Manager / Director in a
- 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.
- Implements current policies and procedures set by the Care
- Conducts on-site or telephonic prospective, concurrent and
retrospective review of active patient care, including out-of-area
- Reviews patients’ clinical records of acute inpatient
assignment within 24 hours of notification.
- Reviews patients’ clinical records within 48 hours of SNF
- Reviews patient referrals within the specified care management
policy timeframe (Type and Timeline Policy).
- Coordinates treatment plans and discharge expectations.
Discusses DPA and DNR status with attending physician when
- Prioritizes patient care needs. Meets with patients,
patients’ family and caregivers as needed to discuss care and
- Acts as patient care liaison and initiates pre-admission
discharge planning by screening for patients who are high-risk,
fragile or scheduled for procedures that may require caregiver
assistance, placement or home health follow-up.
- 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 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. Communication may include patient (or agent),
attending/referring physician, facility administration and Optum
claims as necessary.
- Attends all assigned Care Management Committee meetings and
reports on patient status a defined by the region.
- 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.
- Ensures appropriate utilization of medical facilities and
services within the parameters of the patients’ benefits and/or CMC
decisions. This includes appropriate and timely movement of
patients through the various levels of care.
- Maintains effective communication with the health plans,
physicians, hospitals, extended care facilities, patients and
- Provides accurate information to patients and families
regarding health plan benefits, community resources, specialty
referrals and other related issues.
- Initiates data entry into IS systems of all patients within the
parameters of Care Management policies and procedures.
Maintains accurate and complete documentation of care rendered
including LOC, CPT code, ICD-9, referral type, date, etc.
- Follows patients on ambulatory care management programs,
including CHF and home health, in order to optimize clinical
- 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.
If you need to enter a work site for any reason, you will
be required to screen for symptoms using the
ProtectWell mobile app, Interactive Voice Response (i.e., entering
your symptoms via phone system) or a similar UnitedHealth
Group-approved symptom screener. Employees must comply with any
state and local masking orders. In addition, when in a UnitedHealth
Group building, employees are expected to wear a mask in areas
where physical distancing cannot be attained.
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
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.
Keywords: Optum, Torrance , LVN, Utilization Management, Per Diem, Torrance, Other , Torrance, California
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