Manager Case Management - Remote

Optum; Phoenix (AZ); Remote; USD 89,000 - 177,000; Full time

Job summary

A leading healthcare provider is seeking a Clinical Manager to provide expert clinical and administrative leadership. This role involves overseeing operations, ensuring compliance with patient care protocols, and fostering a team-oriented environment. The successful candidate will have a Bachelor's degree in Nursing, possess a valid RN license, and have significant leadership experience, ensuring top-quality patient care within a supportive and inclusive culture. The position allows for remote work flexibility and offers a competitive salary.

Qualifications

• Graduate from accredited school of Nursing needed.
• Current LVN / RN license required.
• 3+ years of leadership experience.

Responsibilities

• Monitor patient safety and compliance with clinical procedures.
• Evaluate nursing competencies and decisions.
• Mentor and train clinical teammates.

Skills

Clinical Leadership

Patient Care

Regulatory Compliance

Education

Bachelor’s degree in Nursing

Graduate from accredited school of Nursing

Job description

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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.

Position in this function is responsible for providing expert clinical and administrative leadership to teammates within a given department or multiple departments to ensure efficiency of operations and functions. Under the supervision of a clinician, this teammate is responsible for ensuring that all policies and procedures are followed related to patient clinical care and safety. Responsible for performing operational duties as required under the supervision of the Lead clinician, site administrator or designee.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer
• Closely monitors patient safety at all times (i.e. does not leave patient on an exam table unattended) and participates in Optum fall prevention program
• Complies with Optum sharps safety program at all times (i.e. only using devices with safety features and employing safe work practices)
• Ensures appropriate staffing levels by scheduling on a daily and monthly basis within budgetary guidelines
• Ensures compliance in licensing, certification and competencies
• Evaluates nursing competencies and nursing decisions according to current nursing practice
• Mentors and trains teammates in collaboration with the Site Administrator, lead clinician and people services department
• Functions as a resource and serves as a liaison between administration, clinicians, teammates, other departments, patients and vendors
• Provides direct patient care as needed
• Participates in Nursing Leadership, Nurse Peer review and other committees as needed
• Identifies and participates in quality improvement projects for the site
• Conducts monthly teammate meetings to evaluate departmental needs and to communicate operational updates
• Maintains clinical standards outlined in the clinical operations policies and procedures manual
• Identifies deficiencies and recommends changes
• Participates in educational programs to enhance nursing and management knowledge
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Anticipates the needs of the Primary Care Physician (PCP) and carries out orders
• Checks Electronic Health Records (EHR) for patients' arrival status and escorts patients from waiting area to exam rooms
• Assists clinician and teammates in responding to patient emergency situations as per Emergency Response Protocols
• Transports dirty equipment, performs appropriate cleaning, disinfecting, autoclaving, cold sterilization, maintains autoclave, cidex and A-test logs as needed
• Ensures monthly expiration logs for medications and sample medications (refrigerated and non-refrigerated) are maintained
• Instructs patient on lab, radiology, and other procedure / testing preparations
• Participates in visit closure with patient and clinician by explaining next steps for lab, X-ray, referrals, Durable Medical Equipment (DME), etc.
• Escorts patients to ancillary services when needed
• Facilitates the transfer of pertinent patient information between site and referred Specialists, Hospitals, Urgent Care Centers, Ancillary Testing Facilities, etc.
• Forwards all pre-op information to hospital surgeon
• Schedules appointments
• Registers new patients and refers them to the Eligibility department as needed
• Ensures the "No shows" are entered into IDX, and performs "No Show" follow up process
• Works bump list
• Maintains immunization records and updates EHR (including California Immunization Registry (CAIR)).
• Assists with the completion of appropriate forms (DMV, disability, etc.)
• Updates patient demographic information in IDX
• Performs patient record audits
• Answers, directs, and follows up on incoming calls
• Calls patients as requested by clinician
• Distributes incoming correspondence (faxes, consult notes, test results, etc.)
• Participates in handling patient concerns, forwards form to the Patient Liaison or supervisor and responds to patient complaints if appropriate
• Completes Care Team compliance measures on a daily basis (department specific)
• Assists with Quality Metrics, Comprehensive Health Assessment Programs (CHAPS) formally HCC research, telephone call procedures, and patient follow up procedures
• Participates in preparing department for internal and external site audits (facility site reviews) from SCAN, DHS, etc.
• Interacts with the Patient Support Center, Eligibility department and Pharmacy Support Center
• Participates in teammates / clinician “huddles”
• Participates regularly in site teammates and department meetings
• Covers teammate positions as needed
• May assists with site marketing activities (i.e. health fairs, senior Olympics, flu clinics and other events).
• Conducts pre and post-operative teaching for the patient, taking into account all psychological, physiological and religious aspects
• Works in collaboration with a clinician to prepare, monitor and discharge patients after a procedure
• Cleans and stocks exam and procedure/surgery rooms
• Serves as a relief for the teammates.
• Assists with all departments specific functions within the RN scope of practice
• Ensures monthly expiration logs for medications and sample medications (refrigerated and non-refrigerated) are maintained
• Ensures yearly expiration logs for Preventative Maintenance (PM) are performed as needed
• Ensures EKG reconciliation is performed and confirmed EKG’s are seen by clinician before patient is discharged
• Ensures referral tickler file / log are maintained
• Ensures immunization records and updating EHR (including California Immunization Registry (CAIR)) are performed
• Participates in all Nursing Leadership regional meetings and Nurse Peer Review as needed
• Conducts monthly teammate meetings to evaluate departmental needs and to communicate operational updates
• Participates in verifying medications and vaccine doses for non-licensed teammates
• Mentors and trains teammates in collaboration with the Site Administrator, lead clinician and people services department
• Completes all mandatory online clinical education as assigned by clinical educators and immediate supervisor
• Obtains, interprets, records and reports vital signs (temperature, pulse, respiration and blood pressure), height, weight, and other pertinent patient information to clinician
• Develops an appropriate nursing care plan
• Implements a plan of care by performing nursing interventions and assisting with procedures
• Instructs patient on procedural preparations
• Administers medication and other therapeutic modalities within the scope of practice of a Registered Nurse
• Collects, labels and transports various specimens to appropriate destinations
• Performs patient and family teaching
• Documents and maintains records of medical and nursing procedures
• Coordinates with clinicians and ancillary departments to plan daily work assignments according to teammates abilities, clinician and patient schedules, patient flow and procedures
• Ensures adequate levels of supplies are maintained
• Ensures that all equipment is maintained
• Performs comprehensive patient assessment and triaging
• Directs patients to appropriate levels of care and authorizes outside services
• Notifies pharmacies of new prescriptions and authorizations of refills as ordered by clinician
• Participates in educational programs to enhance nursing knowledge
• Adheres to standard precautions at all times
• Adheres to safety policies and procedures at all times
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Frequently monitors overdue orders and follows approved process to address the orders
• Assists with Meaningful Use (MU) initiative by encouraging patients to sign up for Follow My Health (FMH), obtaining patient’s email addresses, updating smoking status, and other initiatives
• Assists clinicians with medication reconciliation per guidelines
• Uses approved standing orders to perform, order test and update referrals
• Assists with entering referrals in electronic health records EHR for clinician to authorize
• Enters medical billing charges for services rendered in EHR
• Participates in verifying medications and vaccine doses for non-licensed teammates
• Mentors and trains teammates in collaboration with the Site Administrator, lead clinician and people services department
• Attends in all mandatory Clinical Teammate Orientation (CTO) (both instructor led and online courses), Annual Clinical Updates, and Skills validation including those that could be held after working hours including the weekend
• Participates in facilitation of annual skills validation for Medical Assistants take place during evening hours and or weekends (selected Saturdays only)
• Ensures all Patient Intervention Reports (PIR) have been reviewed and actions taken
• Assists clinician and licensed nursing teammates in responding to patient emergency situations as per Emergency Response Protocols
• Verifies that the informed consents for procedures have been signed, dated and witnessed
• Assists with Quality Metrics, Comprehensive Health Assessment Programs (CHAPS) formally HCC research, telephone call procedures, and patient follow up procedures
• Prepares labels, collects and transports various specimens to appropriate destinations
• Cross trainings to work in other departments or other duties as assigned by supervisor /management
• Performs additional duties as assigned
• Accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  
  

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.

Required Qualifications

• Bachelor’s degree from a four-year college and/or a professional certification requiring formal education beyond a two-year college preferred
• Graduate from an accredited school of Nursing
• Current LVN / RN license
• Current Cardio-Pulmonary Resuscitation certification
• Current Basic Life Support for Providers, by American Heart Association (AHA)- (100% online certification is not acceptable)
• ACLS and/or PALS certification preferred- (100% Online certification is not acceptable)
• 3+ years of leadership experience (supervisor and above) with direct reports
• Intermediate level of experience with Microsoft Suite
  
  

Preferred Qualifications

• Master's degree or demonstrated equivalent experience
• Supervisory experience
• Ambulatory care experience
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group 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.

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

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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