Case Manager RN - Per Diem 2381909 | Boulder, Colorado

Case Manager

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? 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.

Schedule: Required to work one weekend shift every two weeks. Other days as needed.

NOTE: Qualified candidates must live in the Boulder CO regional area and be willing to work onsite at a hospital facility (not a remote work-from-home position.

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
• Responsible for 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) or ability to obtain within 6 months of hire
• 2+ years of experience 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 one weekend shift per two weeks and availability as needed

Preferred Qualifications:

• Case management experience or certification
• Knowledge or understanding of community resources, policies, and procedures
• 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
• Solid written and verbal communication skills
• Self-motivated and able to function in a fast-paced work environment
• Meets and maintains quality and productivity standards
• Solid working knowledge of Microsoft packages
• Ability to learn and understand various clinical software applications
• Proficient typing skills
• Effectively solves problems and actively pursues resolution
• Critical thinking and organizational skills

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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: 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.