For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
Position in this function is responsible for utilizing the appropriate resources while working closely with physicians, specialists, care managers, and facility nurses or representative to coordinate patient's transition to contracted facility or next level of care within the parameters of established contracts and patient's health plan benefits. Performs job functions telephonically or at on-site office as the need arises. Reports findings to the department management team in a timely manner.
If you reside in California with a valid LVN nursing license, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer
Coordinates ED repatriations, safe transfers, and discharge instructions as directed and approved by the regional hospitalists and/or on-call hospitalists; or as tasked by regional inpatient teams
Delegates provisions for discharge including follow-up appointments, home health, social services, transportation to care coordinators to ensure appropriate and timely movement of patients through the various levels of care
Diligent in obtaining additional clinical information or overcoming lack of transportation from hospital to home in order to prevent delay in discharge or transfer
Consistently and accurately completes documentation for any post stabilization requests, MD to MD determination and level of care decision
Approves medically appropriate referrals within required regulatory timeframes in order to facilitate safe discharges or transfers
Ensures appropriate utilization of medical facilities and services within the parameters of the patients' benefits
Maintains effective communication with the physicians, hospitals, extended care facilities, and when necessary patients and families
Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of Division of Financial Responsibility (DOFR)
Communicates authorization or denial of services to appropriate parties and may include patient (or agent), attending / referring physician or facility administration
Reviews expedited appeal notifications, prepares and sends appeal packets with requested information to Livanta and health plans within timeframes outlined
Writes Detailed Notice of Discharge (DND) and Detailed Explanation of Non-Coverage (DENC) to include in Livanta appeal packets
Reviews appeal decisions received from Livanta and health plans, updates referral management system and provides evidence to health plans as requested
Refers patient for PDV appointment immediately after discharging/leaving AMA from Emergency department to home
Responsible to track team caseloads, completes staffing schedule, and escalates issues to management as needed
Seeks and identifies opportunities for process improvement
Expected to participate in weekend and holiday coverage rotation per business needs
Meets or exceeds productivity targets
Uses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Performs additional duties as assigned
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:
Graduation from an accredited Licensed Vocational Nurse program
Current, unrestricted California LVN License
1+ years of experience working as an LVN/LPN
1+ years of case management, utilization review or discharge planning experience
Preferred Qualifications :
3+ years of clinical experience working as an LVN/LPN
Experience in an HMO or experience in a Managed Care setting
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
California Residents Only : The hourly range for this role is $19.47 to $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
