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RN Manager of Case Management Optum CA La Palma

Company: UnitedHealth Group
Location: Buena Park
Posted on: June 17, 2022

Job Description:

***10,000 Sign On Bonus for External Candidates*** Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm) This position provides daily operational direction to the Inpatient Services Department including oversight and supervision of Inpatient Case Managers. Manages exempt and non-exempt employees. Works collaboratively with the Medical Director for Inpatient Services and Acute and Post-Acute Services to ensure patients are cared for at the correct facility according to risk arrangements. Primary Responsibilities:

  • Direct supervision of licensed and unlicensed staff
  • Preparation for case review meetings including health plan specific reviews as directed by Director of Management
  • Acute and SNF Inpatient management (reviews, denials, transfers)
  • Case Management as necessary
  • Oversight of discharge planning
  • Works directly with hospitalists to facilitate appropriate length of stay and resolution of specialist issues as assigned by Director of Case Management
  • Provide ongoing educational opportunities to staff, ensuring an understanding of the business processes, technology used within the organization, regulatory compliance, program standards and outcomes
  • Ongoing staff development on the utilization of appropriate criteria
  • Claims review
  • Oversight of the Out of Network transfer process
  • Identification and referral of High-Risk members to the Comprehensive Care Clinic and/or Case Management
  • Preparation of inpatient denial letters including DENC as required.
  • Assists with health plan audits and surveys
  • Responsible for on-call nurse staffing schedules
  • Provide written documentation/reports to the Director of Clinical Services or other members of the Clinical Services Management team as requested, routine and/or ad hoc
  • Analyze necessary data to support informational findings
  • Other duties as assignedYou'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:
    • Active RN or LVN license in the State of California without restrictions
    • 2+ years of experience in inpatient managed care environment, preferably in an IPA or MSO
    • 2+ years of supervisory experience
    • Knowledge of MCG guidelines
    • Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance Preferred Qualification:
      • Associate degree To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment. UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 5, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good. Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed. Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams. Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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) **PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus. 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.

Keywords: UnitedHealth Group, Buena Park , RN Manager of Case Management Optum CA La Palma, Executive , Buena Park, California

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