Field Based RN Case Manager - East Valley - Mesa, AZ - Full-time / Part-time

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)

Our Nurse Case Managers are responsible for the coordination of care for patients in the inpatient and community setting to determine medical appropriateness by following medical guidelines and benefit determination.

The RN Case Manager acts as an advocate for members and their families by linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence.

The RN Case Manager is responsible for the case management activities across the continuum of care including coordination of care, medical management consulting and may also provide health education, coaching and treatment decision support for members. The RN Case Manager participates in interdisciplinary conferences and Patient Care Coordination Meeting (PCC) to review clinical assessments, update care plans and determine follow-up frequency with the team.

Please note: This is a full time, Monday-Friday position. The RN must be able to travel throughout the followings areas in order to conduct face to face visits with patients and their families: Mesa, Mesa, Chandler, Queen Creek and Apache Junction. Onsite visits are required and will be conducted at long term care, acute rehab and home settings. The office is located in Phoenix and attendance to bi-monthly meetings at the office is required.

Major Responsibilities for the RN Case Manager include:

• Collaborates effectively with interdisciplinary team (IDT) to establish an individualized plan of care for members and identifies both short and long term goals


• Works with the Utilization Management nurses, Care Coordinators and Post-Acute Team to facilitate smooth care transitions


• Serves as the clinical liaison with hospital, clinical and administrative staff as well as provides expertise for clinical authorizations for inpatient care based on utilized evidenced-based criteria


• Stratifies and/or validates patient level of risk and communicates during transition process with IDT


• Ensures standardized execution of workflow processes, such as increase in admissions, monthly audits, referral to case management and RTAs


• Provides assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or member's home


• Develops interventions and processes to assist the Health Plan and/or MSO member in meeting short and long term plan of care goals


• Coordinates and attends member visits with PCP and specialists as needed.


• Reviews patient charts onsite, telephonically or electronically through Milliman Care Guidelines


• Manages assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process directly monitoring assigned members


• Confers with physician advisors on a regular basis regarding inpatient cases and participates in departmental utilization rounds.


• Plans member transitions, with providers, patient and family


• Attends and Participates in interdisciplinary team meetings as directed


• With the assistance of the UM team, guides physicians in their awareness of preferred contracts and providers and facilities


• Enters timely and accurate data into designated care management applications as needed to communicate patient needs and maintains audit scores of 90% or better on a quarterly basis

Required Qualifications:

• Current, unrestricted RN license in the state of AZ


• Minimum 2 years of case management experience


• Minimum 3 years of experience in an acute care and/or hospital setting


• Experience using EMR, UM and/or Prior Authorization systems


• Possess planning, organizing, conflict resolution, negotiating and interpersonal skills


• Experience with Microsoft Office applications including Word, Excel, and Power Point


• Independent problem identification/resolution and decision making skills


• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously


• Reliable transportation including valid driver's license and automobile insurance

Preferred Qualifications:

• Experience working with geriatric patient populations


• Knowledge of utilization management, quality improvement, discharge planning, and cost management


• Bilingual (English/Spanish) language proficiency


• CCM certification


• Milliman and/or Interqual experience


• Coding experience/knowledge

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. 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. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: RN, registered nurse, case manager, case management, discharge planning, transitional care, Phoenix, Mesa, AZ, Arizona