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This position is responsible for ensuring the continuity of care in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits. Facilitates continuum of patients’ care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site or telephonically as the need arises. Works in conjunction with the care team and PCP as care team leader. Ensures evaluation is in alignment with site-based goals.

Primary Responsibilities:

• Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer

• Represents the Company in a professional manner, following all Company policies and procedures

• Uses, protects, and discloses patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

• Be able to obtain CPR certification within 90 days of employment (Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)

• LPNs: Be able to obtain IV Certification within 90 days of employment

• Prioritizes patient care needs upon initial visit and addresses emerging issues

• Meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan as delineated in Transitions of Care program

• Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings

• Consults with physician and other team members to ensure that care plan is successfully implemented

• Coordinates treatment plans with the care team and triages interventions appropriate to the skill set of the team members

• Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes

• Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management

• Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care

• Works in coordination with the care team and demonstrates accountability with patient management and outcome

• Discusses Durable Power of Attorney (DPoA) and advanced directive status with PCP when applicable

• Maintains effective communication with the physicians, disease management, hospitalists, extended care facilities, patients and families

• Provides accurate information to patients and families regarding plan benefits, community resources, referrals and other related issues

• Documents pertinent patient information in Electronic Health Record and FOCUS as appropriate

• Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports

• Adheres to departmental policies and procedures as approved by Best Practice Committee and QMOC (Quality Medical Oversight Committee)

• Work collaboratively with the provider and care team to carry out nursing interventions under proper scope of practice

• Performs additional duties as assigned

• Travel as necessary, or cover centers remotely, based on business need

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 graduate, GED or equivalent

• Graduation from an accredited school of Nursing

• RNs: Associate's or Bachelor’s degree in Science

• LPNs: IV Certification

• Current and valid LPN or RN Florida state license

• Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)

• Experience in an acute clinical care setting or equivalent

• Care management, utilization review or discharge planning experience

• Proven knowledge of current standards of patient care

Preferred Qualifications:

• Bachelor’s degree in Nursing

• 1+ years of experience in an acute clinical care setting

• HMO experience

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.