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This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions. Medical Management includes observation level patients, acute long-term level patients and the development of plans of care to for transitions of care at discharge. This positions is responsible for the daily operations of medical management case managers in the assigned facilities. Collection and oversight of documentation and safety of RN decisions at discharge. Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.
Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members. Ensure members receive quality medical care in the most appropriate setting. Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2) Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director
Primary Responsibilities:
- Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requests
- Provide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutions
- Identify barriers so that staff can maintain high productivity and high levels of morale
- Ensure coordination between other internal departments as well as external companies as appropriate
- Develop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departments
- Independently manage work flows including orientation, standard work and report concerns to the director
- Collaborates on decisions to promote teamwork
- Collaboration with Sr. Medical Director and V.P.
- Promote LEAN work cycles for performance enhancement
- Provides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and mission
- Other duties as assigned in medical management
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:
- High School diploma and/or equivalent
- Active unrestricted Nevada RN license
- Obtain CCM certification within 2+ years of employment
- Valid Nevada driver's license and maintain personal auto insurance coverage
- 1+ years of related professional experience in managed care environment
- 1+ years related supervisory/management experience
- Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas
- Solid technology skills and excellent interpersonal skills
- Proven ability to negotiate and arbitrate without difficulty
- Proven ability to supervise multiple levels of people
- Critical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care
Preferred Qualification:
- Bachelor's degree
Working Conditions:
- Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management
- Driving up to one hour per day.
Competencies for High Performers:
- Participation in departmental projects assigned by Director or Manager.
- Certification in Case Management (CCM) or equivalent Professional Certification (ACM).
- Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members. Number of IDT completed within the week with Medical Director.
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 salary for this role will range from $91,700 - $163,700 annually 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 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.
OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.