RN Case Manager - Optum : Job Details

$7,500 Sign on bonus for External Candidates

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 to start Caring. Connecting. Growing together.

Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

The Nurse Case Manager is responsible for performing case management within the scope of licensure for patients with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring and evaluating care plans designed to optimize health care across the care continuum and ensuring patient access to services appropriate to their health needs. Basic counseling skills and a positive, enthusiastic and helpful personality are a must. Activities include coordination and oversite of care plans and services of a defined patient population program to promote effective utilization of services and quality patient care.

Primary Responsibilities:

• Population Management
  • Analyzes data related to patient populations/conditions and develops a plan of action. Monitors progress over time and initiates changes as needed
  • Identifies patient populations requiring care management support
  • Assesses patient populations to identify those resources or other factors needed to achieve the desired outcome for health maintenance or health improvement
  • Coordinates healthcare interventions for populations with significant health conditions in which self-management efforts are critical
  • Maintains appropriate patient educational materials for populations of patients to meet the needs of patients and families in order to assist with the facilitation of their participation in the plan of care
  • Develops strategies to meet the preventive care and health maintenance measures for populations of patients
  • Develops professional relationships with community resources that are used by OMG to care for populations of patients. (e.g. Home health, hospice)
• Disease Management
  • Assists in the management of patients with chronic diseases following established protocols and systems for disease management in collaboration with providers
  • Assesses patient learning needs and has the ability to develop and implement individualized educational or care plans. Reviews, evaluates and revises the plan on an ongoing and timely basis. Develops self-management goals and monitors the progress of the goals
  • Communicates with a multidisciplinary team (physicians, nurses, therapists, social workers, etc.) as needed to assist with disease management
  • Has the ability to oversee and assist the patient with referral navigation
  • Initiates disease-specific care conferencing as needed
  • Utilizes patient communication strategies, e.g. motivational interviewing, to involve the patient in developing a plan of care, goals or other specific measures pertinent to their health condition
  • Assesses patient activation and readiness for change and uses these to develop self-management goals
  • Documents all disease management encounters using standardized processes
• Utilization Management
  • Possesses analytical skills to assess various patient utilization measures, such as ED, Urgent Care and Hospital Visits
  • Oversees ED, Urgent Care and Hospital admission utilization rates
  • Collaborates with the Leadership team to develop a plan of action to maintain acceptable utilization rates
• Leadership
• • Works collaboratively with the MA, Community Health Worker or LPN Clinic Coordinator, to promote activities that support the overall goals of the organization related to caring for different populations of patients
  • Engages the back office team and partners with leadership to support the population, disease and utilization management process goals and initiatives
  • Effectively communicates with staff members and providers. Can role model excellent communication skills
  • Works collaboratively with the leadership team to ensure that the staff comprehend and are compliant with the policies and procedures that relate to population, disease and utilization management
• Quality
  • Monitors monthly quality measures, looks for trends and makes plans for improvements. Identifies problem areas for monitoring and evaluation and is active in analyzing findings, changing practice based on the findings. Works with the Quality Manager on process and informs staff of trends and areas where improvement is needed
  • Serves as an educational resource and provides consultation to other staff on utilizing evidence-based criteria to maintain quality measures
  • Participates, as a Clinic Team Member, in Quality Improvement Projects and Initiatives
  • Perform other 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:

• Graduate from an accredited school of nursing
• Current Oregon Registered Nurse license
• Current healthcare level BLS/CPR certification or the ability to obtain within 30 days of employment
• Current Oregon driver license in good standing and reliable & insurance transportation
• 3+ years of experience as a licensed RN with recent clinical experience or less RN experience with other/related healthcare experience
• Knowledge of community resources
• Demonstrated knowledge and understanding of information technology

Preferred Qualifications:

• Experience participating in a team-based model
• Experience in motivational and health coaching with patients

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.

Diversity creates a healthier atmosphere: OptumCare is an 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.