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
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
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.
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.
