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Bilingual Case Manager LPN - Miami - Dade County, FL - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Miami, FL Miami, Florida |
About this job
Position Description:Energize your career with one of Healthcare’s fastest growing companies.   You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our Service Centers, improve our Service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 14 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions, and treatments; helping them to navigate the system, finance their Healthcare needs, and stay on track with their Health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation, and Performance.Â
If
the hired individual resides in Florida (office based or telecommuting) this
position requires the AHCA Level II background check (fingerprinting) by the
State of Florida for all clinicians that have direct face to face contact with
members and will require renewal every five years.
 Primary Responsibilities:Document Milliman Guideline(s) on every inpatient case within 24 hours of receipt and update guideline as hospitalization continues.Review inpatient cases with UM Manager on a daily basis and communicate discharges by 12 noon.Notify patients’ Primary Care Physician of admission, discharge and discharge plan within 24 hours of each event as appropriate.  Utilize the nursing process to establish individual patient goals and measures patients’ response to the plan of care for appropriate outcomes and intervene appropriatelyExplore care options to reduce cost, decrease length of stay, curtail re-admission and influence quality outcomes.Maintain knowledge regarding network providers and current contracted specialistsUnderstand health plan benefits and contractual information.Generate authorizations utilizing principles of UMAccurately use database for daily documentation of clinical information, opportunity days, denied days and levels of care.Follow policy and procedure for Denials and enters this information into the database with 24 hours of the event.Meet all health plan contract compliance directives for utilization.Maintain ongoing communication and feedback with customers and/or clients in order to support needs and resolve problems.Attend weekly/monthly group committees as requested.Manage error reports on a weekly basis.Communicate activities and progress of assigned committees and teams to appropriate staff.Identify and refer members to Case Management prior to discharge or as deemed appropriate through referral review.Assure discharge plans are implemented.Confer with Hospitalist on call as appropriate.This position will cover Miami-Dade County, FL
If
the hired individual resides in Florida (office based or telecommuting) this
position requires the AHCA Level II background check (fingerprinting) by the
State of Florida for all clinicians that have direct face to face contact with
members and will require renewal every five years.
 Primary Responsibilities:Document Milliman Guideline(s) on every inpatient case within 24 hours of receipt and update guideline as hospitalization continues.Review inpatient cases with UM Manager on a daily basis and communicate discharges by 12 noon.Notify patients’ Primary Care Physician of admission, discharge and discharge plan within 24 hours of each event as appropriate.  Utilize the nursing process to establish individual patient goals and measures patients’ response to the plan of care for appropriate outcomes and intervene appropriatelyExplore care options to reduce cost, decrease length of stay, curtail re-admission and influence quality outcomes.Maintain knowledge regarding network providers and current contracted specialistsUnderstand health plan benefits and contractual information.Generate authorizations utilizing principles of UMAccurately use database for daily documentation of clinical information, opportunity days, denied days and levels of care.Follow policy and procedure for Denials and enters this information into the database with 24 hours of the event.Meet all health plan contract compliance directives for utilization.Maintain ongoing communication and feedback with customers and/or clients in order to support needs and resolve problems.Attend weekly/monthly group committees as requested.Manage error reports on a weekly basis.Communicate activities and progress of assigned committees and teams to appropriate staff.Identify and refer members to Case Management prior to discharge or as deemed appropriate through referral review.Assure discharge plans are implemented.Confer with Hospitalist on call as appropriate.This position will cover Miami-Dade County, FL
Requirements
Required Qualifications: High School Diploma/GED4+ years of LPN experience 1+ years of Managed Care experienceCurrent and unrestricted LPN licensure in the State of Florida Current CPR certification or the ability to obtain certification within 30 days of hire Bilingual in both English and Spanish (written and spoken) Ability to navigate through a Windows environment and to utilize Microsoft Word and Excel to perform data entry, sorting, and filtering Ability to type 30 - 40 WPM Access to reliable transportation, valid and current driver's license, and current auto insurance Comfortable with 75% travel within the local area Flexible to help deliver in neighboring regionsPreferred Qualifications: Knowledge of Medicare and Medicaid Experience with Care Coordination in a Long Term Care environment Experience with EMR (Electronic Medical Records)
At
Optum, you will perform within an
innovative culture that's focused on transformational change in the Healthcare
system. You will leverage your skills across a diverse and multifaceted
business. And you will make contributions that will have an impact that's
greater than you've ever imagined.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
At
Optum, you will perform within an
innovative culture that's focused on transformational change in the Healthcare
system. You will leverage your skills across a diverse and multifaceted
business. And you will make contributions that will have an impact that's
greater than you've ever imagined.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.