LVN, Case Manager - Remote CA

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Optum's Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Under the direction of a Registered Nurse, you will be responsible for ensuring the continuity of care in both the inpatient and outpatient settings utilizing the appropriate resources within the parameters of established contracts and patients' health plan benefits. Facilitate a continuum of patient care utilizing basic nursing knowledge, experience, and skills to ensure appropriate utilization of resources and patient quality outcomes. Perform case management functions on-site or telephonically as the need arises. Lastly you will report the findings to the Case Management department Supervisor / Manager / Director in a timely manner.

If you reside in the state of California, you'll enjoy the flexibility to work remotely * as you take on some tough challenges.

Primary Responsibilities:

• Consistent exhibit behavior and communication skills demonstrating Optum's commitment to superior customer service, including quality, care, and concern with every internal and external customer
• Implement current policies and procedures set by the Case Management department
• Conduct on-site or telephonic prospective, concurrent, and retrospective reviews of active patient care, including out-of-area and transplant
• Review patients' clinical records of acute inpatient assignment within 24 hours of notification
• Review patients' clinical records within 48 hours of SNF admission
• Review patient referrals within the specified care management policy timeframe (Type and Timeline Policy)
• Coordinate treatment plans and discharge expectations. Discusses DPA and DNR status with the attending physician when applicable
• Prioritize patient care needs. Meets with patients, patients' families, and caregivers to discuss care and treatment plans
• Act as patient care liaison and initiate pre-admission discharge planning by screening for patients who are high-risk, fragile, or scheduled for procedures that may require caregiver assistance, placement, or home health follow-up
• Identify and assist with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, and custodial and ambulatory settings. Consult with the physician and other team members to ensure the care plan is successfully implemented
• Coordinate provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
• Communicate authorization or denial of services to appropriate parties. Communication may include patient (or agent), attending/referring physician, facility administration, and Optum claims as necessary
• Attend all assigned Case Management Committee meetings and reports on patient status as defined by the region
• Maintain effective communication with health plans, physicians, hospitals, extended care facilities, patients, and families
• Provide accurate information to patients and families regarding health plan benefits, community resources, specialty referrals, and other related issues
• Follow patients on ambulatory case management programs, including CHF and home health, to optimize clinical outcomes
• Use, protect, and disclose Optum patients' protected health information (PHI) only following Health Insurance Portability and Accountability Act (HIPAA) standards

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 LVN license in California
• 1+ years of recent clinical experience working as an LVN/LPN

Preferred Qualifications:

• 3+ years of clinical experience working as an LVN/LPN
• 2+ years of case management, utilization review or discharge planning experience.
• 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

The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.