NAELA's CareerCenter

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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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

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 the Company’s Mission Vision and Values, and 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
• Ability 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)
• 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)
• Ability to work collaboratively with the provider and care team to carry out nursing interventions under proper scope of practice
• Performs additional duties as assigned
• Ability to travel as necessary, or cover centers remotely, based on business need

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:

• High school graduate or GED equivalent
• Hold state required license and/or certification which allows placement of IVs OR must be willing to obtain within 90 days if required by state (e.g. RN License; LPN + IV Certification)
• Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross) or be able to obtain within 90 days of employment
• Active State of Florida licensure
• Experience in an acute clinical care setting or equivalent
• Care management, utilization review or discharge planning experience
• Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

Preferred Qualifications:

• 1+ years experience in an acute clinical care setting 
• Bachelor’s degree in Nursing 
• HMO experience 
• Knowledge of current standards of patient care
• Knowledge and skill in the applications of the techniques and practices of the nursing profession
• Thorough understanding of RN 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
• Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff
• Ability to be a clinical resource for non-licensed office staff

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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, Health Care, US Healthcare, Fern Park, FL, Florida