Job Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. 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 care management functions on-site or telephonically as the need arises. Lastly you will report the findings to the Care Management department Supervisor / Manager / Director in a timely manner.If you are located within the state of California, you will have 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 customerImplement current policies and procedures set by the Care Management departmentConduct on-site or telephonic prospective, concurrent, and retrospective reviews of active patient care, including out-of-area and transplantReview patients’ clinical records of acute inpatient assignment within 24 hours of notificationReview patients’ clinical records within 48 hours of SNF admissionReview 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 applicablePrioritize patient care needs. Meets with patients, patients’ families, and caregivers to discuss care and treatment plansAct 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