Case Manager RN - Waukesha, WI
Company: Optum
Location: Big Bend
Posted on: September 29, 2024
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Job Description:
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 diversity and inclusion, talented peers,
comprehensive benefits and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start -Caring.
Connecting. Growing together. -
The -Case Manager RN 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. Case Managers facilitate timely care delivery at the
right time, in the right setting, by following CMS guidelines,
escalation of operational barriers, and collaboration with all
stakeholders. Discharge planning will begin at the time of (or
prior to) admission, and reassessed ongoing throughout the course
of hospitalization in partnership with the clinical team, the
patient, and/or the patient's representative. Quality and Risk
Management issues will also be monitored and reported as
appropriate.
Location: -Waukesha Memorial Hospital - 725 American Ave, Waukesha,
WI
Schedule: -Monday - Friday - 8 AM - 4:30 PM CST - Can be flexible -
Every 6th Weekend
Primary Responsibilities:
Takes lead role in directing disposition of patients and
utilization considerations
Assumes leadership role to facilitate interdisciplinary
collaboration
Effectively problem-solves and actively pursues resolution
Directly communicates with staff, physicians, patients, and
families
Role models leadership behavior through courtesy, respect, and
efficiency
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
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
Functions without direct supervision, utilizing time constructively
and organizing assignments for maximum productivity. Arranges
schedules to facilitate meetings with physicians for patient care
rounds, team meetings and other opportunities to improve
communication
Ability to effectively read, write, and speak, cognitively process
and emotionally support performing other duties as assigned
Basic Microsoft Office Skills
All employees are expected to remain flexible to meet the needs of
the hospital, which may include floating to other departments to
assist as patient needs fluctuate
Must be able to functionally coordinate and discharge plan for all
age groups, including but not limited to the unborn child through
geriatric age groups
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
Develop care plans for patients who frequent the Emergency
Department in partnership with the patient's physician, ED
Provider, and community resources
Knowledge of all applicable federal and state regulations. Shows
working knowledge of managed care and Medicare health plans and
reimbursement related to post-acute services within the continuum
of care
Reports all relevant information to the staff assuming
responsibility in the next level of care
Responsible for communicating with the department director LOS and
financial information, and issues that may affect the continuum of
care process
Adheres to name badge/dress code compliance
What are the reasons to consider working for UnitedHealth Group? -
Put it all together - competitive base pay, a full and
comprehensive benefit program, performance rewards, and a
management team who demonstrates their commitment to your success.
Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period
plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending
Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term
disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance,
etc.)
More information can be downloaded at: -
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:
Associate's Degree (or higher) in Nursing
Current, unrestricted RN license in the state of employment
1+ years of experience with/knowledge of community resources,
policies, and procedures
1+ years of clinical experience with/knowledge of age groups,
including but not limited to the unborn child through geriatric age
group -
Preferred Qualifications:
Bachelor of Science
2+ years of case management experience
Case Management Certification
Must have strong analytical, critical thinking and organizational
skills
Knowledge of Utilization Review, Medicare Requirements processes as
well as State and Federal regulations pertaining to Utilization
Review and Discharge Planning
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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.
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. -
#RPO, #RED
Keywords: Optum, Waukesha , Case Manager RN - Waukesha, WI, Executive , Big Bend, Wisconsin
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