LVN or LPN, Case Manager - Remote

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.

• The After Hours Care Manager - LPN. provides inpatient care management services related to discharge planning/coordination; HLOC transfers; ED Diversion. The goal of this position is to enhance the quality of member management, through collaboration with Physicians, facility representatives, and inpatient care coordinators. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance.
• Work Hours Available to work evenings, weekends, holidays. (1) Evening shift with 3 weekends on and 1 weekend off totaling 40 hrs per week, 3pm PST - 1130pm PST and (1) Morning shift with 3 weekends on and 1 weekend off totaling 40 hrs per week, 8am PST - 430pm PST. If you are located in California, you will have the flexibility to work remotely* as you take on some tough challenges.
• Primary Responsibilities
• Performs job function telephonically
• Coordinates safe transfers, and discharge instructions as directed by the hospitalists and Care Management teams
• Delegates provisions for discharge including but not limited to follow-up appointments, home health, social services, transportation to care coordinators to ensure appropriate and timely movement of patients through the various levels of care
• Consistently and accurately completes required documentation
• Approves medically appropriate referrals within required regulatory timeframes to facilitate safe discharges or transfers
• Ensures appropriate utilization of medical facilities and services within the parameters of the patients' benefits
• Maintains effective communication with the physicians, hospitals, extended care facilities, and when necessary, patients and families
• Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of Division of Financial Responsibility (DOFR)
• Communicates authorization or denial of services to appropriate parties and may include patient (or agent), attending / referring physician or facility administration
• Track team caseloads, completes staffing schedule, and escalates issues to management as needed
• Seeks and identifies opportunities for process improvement
• Expected to participate in weekend and holiday coverage rotation per business needs
• Maintains caseload per defined medical management department standards
• Meets or exceeds productivity targets
• Identifies patients appropriate for high-risk post discharge programs and refers accordingly
• Demonstrates ability to work independently and implement innovative approaches to complex member situations
• Performs additional duties as assigned The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.
• Professional Competencies
• Consistently exhibits behavior that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer
• Ability to use written and oral communication skills
• Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff
• Ability to make sound, independent judgments and act professionally under pressure
• Demonstrates effective documentation and verbal communication skills factual, accurate, clear and timely to support delivery of effective patient care interventions and collaborative management
• Demonstrate knowledge of PC applications and other role supportive technology
• Ability to work with multiple computer platforms simultaneously
• Ability to analyze problems and formulate appropriate plans, solutions and courses of action
• Ability to work with frequent interruptions
• Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates
• Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners
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