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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Case Manager is responsible and accountable for coordination of patient services through an interdisciplinary process, which provides a clinical and psychosocial approach through the continuum of care. Through concurrent case management, patients will be assessed to determine appropriateness of admission, continued hospitalization, as well as appropriate level of care. Discharge planning will begin at the time of (or prior to) admission, and reassessed ongoing throughout the course of hospitalization. Quality and Risk Management issues will also be monitored and reported as appropriate. CM may be assigned to various units throughout the hospital or the Emergency Department.
Primary Responsibilities:
The CM will be responsible for integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases
Educates patient/family as to options/choices within the level of care determined to be appropriate. Initiates and ensures completion of all necessary paperwork
Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed
Continuum of Care planning will emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists and case managers from contracted payors when appropriate to determine discharge plan that will be of maximum benefit to the patient. Involve staff from the next level of care in the treatment plan as early as possible to promote continuity and collaboration
Reports all relevant information to the staff assuming responsibility in the next level of care
Employees are expected to comply with all regulatory requirements, including CMS and Joint Commission Standards
Knowledge of all applicable federal and state regulations. Demonstrates a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care
Consults with physician section leaders for support in cases where continued stay is not appropriate, and case managers are unable to come to resolution by working with assigned physician
Communicating with the department director LOS and financial information, as well as issues that may affect the Continuum of Care process
All employees are expected to remain flexible to meet the needs of the hospital, which may include floating to other departments to assist as the patient's needs fluctuate
Reviews the patient plan of care with the multi-disciplinary team. Facilitates and participates in multi-disciplinary team care conferences for patients with complex problems. Communicates in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care
Daily communication and collaboration with the patient care staff to provide continuous assessment, evaluation and continuum planning to assure the patient receives the appropriate level of care at the appropriate time
Coordinates patient care processes to achieve desired quality outcomes and identifies/controls inappropriate resource utilization
Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes. Assures patient rights by offering a choice when appropriate
Professional Accountabilities:
Adheres to name badge/dress code compliance
Effectively solves problems and actively pursues resolution
Directly communicates with staff, physicians, patients and families in a professional and courteous manner
Role models leadership behavior through courtesy, respect and efficiency
Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity. Arranges schedule to facilitate meeting with physicians for patient care rounds, team meetings and other opportunities to improve communication
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:
Registered Nurse (RN) with a current, active, unrestricted RN License in Colorado OR a Social Worker (either a Licensed Clinical Social Worker [LCSW] in Colorado or Master of Social Work [MSW] will qualify)
2+ years working as a clinician in an acute care setting with proficient knowledge of hospital workflows
Live in the Boulder CO regional area (this position is location based and not open to remote work)
Willing/able to work Part Time onsite at our office location in Boulder CO (at lease 5-6 eight-hour shifts per Bi-Weekly pay cycle - including 1 weekend every pay cycle)
Willing/able to participate in holiday rotation cycles
Preferred Qualifications:
Case management experience or certification
Solid working knowledge of Microsoft packages
Knowledge or understanding of community resources, policies, and procedures
Proficient typing skills
Proven solid clinical acumen with the ability to use sound judgment, deductive reasoning, and problem-solving skills
Demonstrates a high level of organization with the ability to stay focused on the detail
Demonstrates collaborative skills and ability to interact with people of diverse backgrounds
Proven solid written and verbal communication skills
Proven self-motivated and able to function in a fast-paced work environment
Proven to meet and maintains quality and productivity standards
Proven ability to learn and understand various clinical software applications
Proven effectively solves problems and actively pursues resolution.
Proven critical thinking and organizational skills
The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.