Registered Nurse

2 weeks ago

Newfoundland and Labrador, Canada Optum Full time
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.

The Case Manager (CM) 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.

Quality and Risk Management issues will also be monitored and reported as appropriate.
Waukesha Memorial Hospital 725 American Ave Waukesha, WI and/or Oconomowoc Memorial Hospital 791 Summit Ave, Oconomowoc, WI 53066 and/or Mukwonago Hospital 240 Maple Court Mukwonago, WI, 53149

Schedule:
When business needs - Day shift (8-hour) – 8 – 4:30 PM with possibility of weekends.
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. 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
Arranges schedules to facilitate meetings with physicians for patient care rounds, team meetings and other opportunities to improve communication
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. 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

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.

Associate's Degree in Nursing
~ Wisconsin RN license in good standing
~2+ years of case management experience
~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

Bachelor of Science
Master of Science in Nursing (MSN)
Case Management Certification
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.

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.

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