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An RN functions as part of the primary care team, and reports to the Clinical Services Manager (CSM). The RN supports the APC and our members to coordinate care services. This role works in close collaboration with all team members and may support multiple providers. The RN works under the direction of the provider, and activities are delegated to the RN by the provider or the team CSM. The RN understands and supports the CPM models of care Institutional Special Needs Plan (ISNP), Institutional Special Needs Plan (IESNP) and Transitions to Skilled (TTS) and works in collaboration with the team to meet the goals of the program. This role will support our members telephonically and in-person in patient settings and home settings.
Primary Responsibilities:
- Establishes and maintains communication and a trusting collaborative relationship with the ICT, member/RP and primary caregiver staff in the ALC and APC.
- Communicates with multiple organizations operational units for seamless coordination of benefits, i.e., utilization review staff, provider relations liaison, pharmacy, etc.
- Reviews member's status and assists to achieve progress toward goals; adjusts the ICP as necessary.
- Performs administrative functions for or on behalf of the PCP and/or APC.
- Participates in program effectiveness analysis and planning.
- Performs member visits and rounding as established and directed by the APC.
- Communicates status of member with APC for evaluation and ICP updates.
- Communicates with member, family/RP, primary caregivers of the community and other members of the ICT with each member visit.
- Assists with other clinical and quality responsibilities for member, e.g., gaps in care.
- Attends meetings on behalf of the APC and communicates updates to the ICP with the ICT.
- Provides clinical educational programs for facility staff.
- Communicates information on behalf of the APC to the member, family/RP and primary caregiver staff at the ALC.
- Coordinates and collaborates with the health plan/client.
- Assists with ACP.
- Performs collection of data including functional status, BMI, vital signs, urine test for proteinuria, IFOBT specimen collection, and other clinical data. Results are entered into EMR and reviewed by APC.
- Performs care coordination activities within the ALC to ensure member needs are met (i.e., member external provider appointments, therapy needs, durable medical equipment (DME) and transportation).
- Stays abreast of all Model of Care (MOC), documentation and policy updates communicated via email, newsletters and team meetings.
- Maintains an understanding of and utilizes clinical resources independently including but not limited to Resource1, iCoreCodeGenius, Sparq, Learnsource and other Optum internal sites.
- Maintains confidential health information according to state and federal regulations including HIPAA.
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:
- Current unrestricted Registered Nurse license in Ohio.
- 3+ years of RN experience.
- 1+ years of case management experience.
- Valid driver's license and the ability to travel locally 75% of the time.
Preferred Qualifications:
- BSN.
- Experience with using electronic medical records.
- Experience working in post-acute care, such as long term care or hospice and/or Case Management experience as an RN.
- Experience working with the geriatric population.
- Basic Microsoft Office skills with the ability to navigate in a Windows environment.
- Familiarity with the long term care business environment.
- Proven excellent communication and customer service skills.
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 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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