Case Manager RN - Per Diem - 2206302

Location

Waukesha, WI | United States

Job description

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and  your life’s best work. SM

As a member of the Care Management team, the Case Manager (CM) is responsible for facilitation of precertification and payor authorization processes and status determination at the point of entry in to the hospital from outpatient areas including cath. lab, day surgery and physician offices. This position will proactively prevent denials through assessment and application of Milliman Care Guidelines to determine status for appropriate reimbursement and bed placement. RN CM also facilitates collaborative management of patient care across the continuum, intervening as necessary to remove barriers to timely and efficient care delivery and reimbursement. RN CM’s actively participate in the discharge planning process for all patients working collaboratively with payors, providers, patients and families.

Hours: Variable day shift when business needs 

Locations: Waukesha Memorial Hospital 725 American Ave, Waukesha, WI 53188 and Oconomowoc Memorial Hospital 791 Summit Ave, Oconomowoc, WI 53066, will be working within both hospital locations when business requires coverage. 

Primary Responsibilities:

• Develops and reviews discharge plan and shares with health care team in a timely manner, providing necessary coordination and support to improve performance and to reduce length of stay
• Participates in department rounds and coordinates resources and appropriately documents in Epic, follows policies and procedures relating to Utilization Review/Case Management to support improved reimbursement and reduction of observation stays and custodial stays
• Accurately answers questions regarding payor guidelines
• Acts as a liaison with outsides entities, including, but not limited to, physicians, hospitals, health care vendors, social service agencies, member advocates, and regulatory agencies
• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity
• Establishes and maintains positive communication and professional demeanor with internal and external customers, providers, and members at all times
• Stays current with policies and procedures and Medicare requirements
• Understanding of CMS (Center for Medicare and Medicaid Services) regulatory guidelines and reimbursement rules
• Coordinates patient care processes to achieve desired quality outcomes and identifies/controls inappropriate resource utilization
• 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 
• Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes.  Assures patient rights by offering a choice when appropriate
• 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
• Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity.  Arranges schedule to facilitate meeting with physicians for patient care rounds, team meetings and other opportunities to improve communication
• All other 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:

• Associate’s Degree (or higher) in Nursing 
• Current Active RN Licensure in the State of Wisconsin 
• BLS Certified or able to obtain 6 months from employment
• 1+ year of previous case management and/or discharge planning experience 

Preferred Qualifications:

• Case Management Certification
• Previous Utilization Management experience 
• Previous InterQual experience
• Excellent communication and negotiation skills
• Strong analytical and computer skills with prior EPIC 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: 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.

#RPO #Red

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Salary