OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.
By providing 60 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.
As a Case Manager, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating. This may include case management, disease management, coordination of care and medical management consulting. You will also be responsible for providing health education, coaching and treatment decision support for members.
SHIFT ***Monday-Friday, 11am to 8pm (with an hour lunch break) or 11:30am to 8pm (with a 30 min lunch break)***
Primary responsibilities:
- Making outbound calls to assess members' current health status
- Identifying gaps or barriers in treatment plans
- Providing patient education to assist with self management
- Interacting with Medical Directors on challenging cases
- Coordinating care for members
- Making referrals to outside sources
- Coordinating services as needed (home health, DME, etc)
- Educating members on disease processes
- Encouraging members to make healthy lifestyle changes
- Documenting and tracking findings
- Utilizing Milliman criteria to determine if patients are in the correct hospital setting
- Making "welcome home" calls to ensure that discharged member receive the necessary services and resources
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined. Qualifications:
- Current, unrestricted RN license in the State of Ohio
- 2 years experience in a hospital setting, acute care, direct care experience OR experience as a telephonic Case Manager for another insurance company
- Computer proficiency including the ability to type and talk at the same time and to navigate a Windows environment
Additional Assets Preferred:
- BSN
- A background in managed care
- Certified Case Manager (CCM) is highly preferred
- Experience /exposure with discharge planning
- Experience in utilization review, concurrent review and/or risk management
- Strong organizational skills and multitasking abilities will be keys to success
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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