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Care Manager Pinellas Park FL

Company: UnitedHealth Group
Location: Pinellas Park
Posted on: November 14, 2021

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)This position is responsible for ensuring the continuity of care in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients' health plan benefits. Facilitates continuum of patients' care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site or telephonically as the need arises. Works in conjunction with the care team and PCP as care team leader. Ensures evaluation is in alignment with site-based goals.Primary Responsibilities:

  • Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer
  • Represents the Company in a professional manner, following all Company policies and procedures
  • Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Be able to obtain CPR certification within 90 days of employment (Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)
  • LPNs: Be able to obtain IV Certification within 90 days of employment
  • Prioritizes patient care needs upon initial visit and addresses emerging issues
  • Meets with patients, patients' family and caregivers as needed to discuss care and treatment plan as delineated in Transitions of Care program
  • Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings
  • Consults with physician and other team members to ensure that care plan is successfully implemented
  • Coordinates treatment plans with the care team and triages interventions appropriate to the skill set of the team members
  • Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes
  • Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management
  • Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care
  • Works in coordination with the care team and demonstrates accountability with patient management and outcome
  • Discusses Durable Power of Attorney (DPoA) and advanced directive status with PCP when applicable
  • Maintains effective communication with the physicians, disease management, hospitalists, extended care facilities, patients and families
  • Provides accurate information to patients and families regarding plan benefits, community resources, referrals and other related issues
  • Documents pertinent patient information in Electronic Health Record and FOCUS as appropriate
  • Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports
  • Adheres to departmental policies and procedures as approved by Best Practice Committee and QMOC (Quality Medical Oversight Committee)
  • Work collaboratively with the provider and care team to carry out nursing interventions under proper scope of practice
  • Performs additional duties as assigned
  • Travel as necessary, or cover centers remotely, based on business needYou'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.Required Qualifications:
    • High school graduate, GED or equivalent
    • Graduation from an accredited school of Nursing
    • Possess a current and valid LPN or RN Florida state license
      • RNs: Associate's or bachelor's degree in Science
      • LPNs: IV Certification
      • Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)
      • Experience in an acute clinical care setting or equivalent
      • Care management, utilization review or discharge planning experience
      • Knowledge of current standards of patient care
      • Thorough understanding of RN scope of practice and LPN scope of practice
      • Ability to provide on-site clinical treatment within scope of practice
      • Ability to perform accurate telephonic triages, accurately record findings with follow-up
      • Knowledge and skill in the applications of the techniques and practices of the nursing profession
      • Ability to explain medical instructions to patients and their families
      • Ability to complete a color blindness test
      • Ability to learn and understand appropriate Federal, State, and local regulations
      • Ability to be a clinical resource for non-licensed office staff
      • Ability to perform care management
      • Computer literate
      • Knowledge of HIPAA regulations
      • Ability to read, speak, write, and understand the English language fluentlyPreferred Qualifications:
        • Bachelor's degree in Nursing
        • 1+ years of experience in an acute clinical care setting
        • HMO experience
        • Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff
        • Ability to communicate effectively with patients and all levels of personnel/customers in a professional, courteous and effective manner using excellent customer service skills
        • Ability to make sound, independent judgments and act professionally under pressure
        • Ability to prioritize and multi- task in a high paced environment with good organizational skills
        • Display initiative, accountability and resourcefulnessUnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)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.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: Care Manager, Case Manager, Utilization Review, Primary Care, Managed Care, Care Management, LPN, RN, BLS, CPR, AED, Professional Rescuer, Clinical Care, Care Management, Utilization Review, Discharge Planning, St. Petersburg, Saint Petersburg, FL, Florida, LDMG, LDMG FL

Keywords: UnitedHealth Group, Pinellas Park , Care Manager Pinellas Park FL, Executive , Pinellas Park, Florida

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