On-Site Utilization Mgmt Nurse, RN or LVN - Part-time - Riverside County, CA

• Perform utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management)


• Determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination


• Daily onsite rounds, reviewing of medical records, concurrent review, and discharge planning on inpatient members


• Reviews inpatient cases with UM Manager on a daily basis


• Notifies patient's Primary Care Physician of admission, discharge and discharge plan within 24 hours of each event as appropriate


• Analyzes medical cases for appropriateness and plans and coordinates all phases of care in conjunction with the Hospitalist, attending Physician, Specialists both in the inpatient and outpatient settings


• Utilizes the nursing process to establish individual patient goals and measures patients' response to the plan of care for appropriate outcomes and intervenes appropriately


• Collaborates with physicians, patients, and families to formulate an optimal plan of care that meets all of the medical, psychosocial and financial needs of the patient


• Explores care options to reduce cost, decrease length of stay, curtail re-admission and influence quality outcomes


• Maintains ongoing communication and feedback with customers and/or clients in order to support needs and resolve problems


• Attends weekly/monthly group committees as requested


• Identifies and refers members to Case Management prior to discharge or as deemed appropriate through referral review


• Participates in IPA Grand Rounds providing a concise history and overview of the member's progress and discharge plan. Attends any onsite specialty facility rounds as appropriate


• Other duties as assigned

• Unrestricted LVN license required in California


• 3 or more years of Clinical experience: Hospital or SNF


• Prior-Authorization experience: UM, UR, Concurrent Review, Discharge planning


• Intermediate level of experience with Microsoft Office, with the ability to navigate a Windows environment

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  Unrestricted RN license required in California 


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  Managed Care experience 


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  Bilingual in Spanish


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  BSN 

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)

NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.

Diversity creates a healthier atmosphere: 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.