Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
The Inpatient LVN Case Manager is responsible for managing for the facilitation of the inpatient Utilization Management process including in-network, out of network, case management and discharge planning, along with assisting the Associate Director of Inpatient Management with UM/QM functions as necessary. Acts as a facility liaison to promote cooperation and efficiency between the IPA and the facility.
Standard Hours: Mon-Fri 8:00am-5:00pm. No nights, weekends, or holidays.
Directly performs concurrent review
Accurately identifies and documents level of care
Coordinates, facilitates and documents comprehensive discharge planning
Coordinates in-network services for OON discharges
Ensures the appropriate utilization of capitated and contracted specialists, providers, facilities, and vendors according to region and risk
Attends inpatient review rounds and presents cases to medical director(s), health plans and ACMM management staff
Facilitates OON transfers to In-Network facilities
Works collaboratively with internal and hospital contract staff:
Initiates letter of agreement for OON services in a timely manner
Provides input for potential contracts
Identifies and communicates high dollar / high risk cases
Oversees the utilization of contracted facilities and reports OON utilization
Develops and maintains relationships with both network and Out of Network hospital UM and ER staff
Works directly with AppleCare Hospitalists to develop and implements inpatient processes including, but not limited to:
Identification of patients and referral to specialty clinics such as Comprehensive Care (high-risk) Clinic, Anti-coagulation and/or Diabetic Clinic
Facilitates and ensures timely communication between PCP and Hospitalists
Provides direct Case Management activities if necessary
Identifies readmit for CM coordination
Identifies Healthy Families and Medi-Cal members for CCS referral and facilitates those referrals
Identifies and coordinates high dollar/high risk patients to case management
Participates in UMC/QIC, PCP, Provider Office Meetings, health plan JOMs, and hospital JOCs as assigned
Participates in inpatient UM/QM projects and completes in a thorough and timely manner
Other duties as assigned which may include weeknight, weekend, and holiday on-call
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.
High School Diploma or GED
Current and unrestricted LVN license for the state of California
1+ years of experience in a managed care environment, SNF, IPA or MSO. Other case management experience will be considered
Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment
Case Management Certification (CCM)
Bilingual Spanish speaking (ability to read, write, speak)
Knowledge of and experience with the utilization of UM criteria such as Milliman & Robertson, Medicare and Medicaid guidelines, health plan criteria, etc.
Knowledge of standardized CMS, Medicare Advantage, HMO, and Medi-Cal benefits structures
Solid Microsoft office Word, Excel and internet skills
Thorough clinical knowledge of common inpatient diagnoses
Understanding of DRGs
Solid organizational skills
Ability to perform complex problem soling
Ability to work effectively with physicians
Knowledge of HMO, MSO, and ACO structures and operations
Solid people skills
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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.
Job Keywords: Inpatient LVN Case Manager, Inpatient Nurse, Inpatient RN, Inpatient Case Manager, Nurse Care Manager, RN, Case Management, Certification In Case Management (CCM), BSN, Utilization Management, Quality Improvement, Discharge Planning, Skilled, SNF, Millima
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