2305394-Case Manager – Safe Discharge Unit – Kelsey Seybold Clinic – Hourly

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.  

 

Primary Responsibilities:

• Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members
• Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced-based criteria within the documentation system
• Performs expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out 
  of network facilities.
• Interacts and effectively communicates with ED staff, members, and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information
• Identifies member’s ED discharge support opportunities level of risk by monitoring real-time ADT feeds and communicates with patient, ED, and outpatient teams for discharge coordination
• Conducts transition of care outreach following ED discharge to confirm access and completion of discharge plan
• Refers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical bounds
• Monitors for any quality concerns regarding member care and reports as per policy and procedure
• Manages assigned case load in an efficient and effective manner utilizing time management skills
• Takes on-call assignment as directed
• Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities
• Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
• Adheres to organizational and departmental policies and procedures
• Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines
• Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better monthly
• Performs all other related duties as assigned

 

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.

The ED RN Case Manager monitors real-time ‘Admit, Discharge, Transfer’ (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care. Actively supports ED discharge follow-up care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate next site of care in collaboration with the hospitals/physician team and available outpatient ecosystem resources (PCP, specialist, in-home care, etc.).

 

Required Qualifications:

• Associate degree or higher
• Current, unrestricted Multistate RN license
• 4+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions
• Knowledge of utilization management, quality improvement, and discharge planning
• Special Skills A
  • Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
  • Demonstrated ability to read, analyze and interpret information in medical records, and health plan documents

  • Demonstrated ability to problem solve and identify community resources

     

• Other
  • Proven ability to possess planning, organizing, conflict resolution, negotiating and interpersonal skills
  • Proven ability to utilize critical thinking skills, nursing judgement, and decision making skills
  • Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
  • Proven ability to provide support 24/7

 

Preferred Qualifications:

• Experience working in the Emergency Department
• Experience with managed care and/or case management experience

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare 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.

 

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