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Optum Telephonic Post-Discharge RN

UnitedHealth Group

Raleigh, NC
Job Code:
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Job Details

Optum Telephonic Post-Discharge RN(Job Number:726380)

As an Optum Telephonic Post-Discharge RN you will coordinate the discharge plans of the members assigned to your caseload. You will be responsible assisting the APC in achieving the value based goals of the TTS program, readmission, length of stay, engagement rate and HEDIS / Star measures
Hours:  Monday - Friday 8:00am - 5:00pm, no nights, holidays or weekends.    
Primary Responsibilities:
  • Assist APC in entering past medical / social / family history in the EMR
  • Assist the APC in entering medications completely and accurately in the EMR to assist the APC in medication reconciliation
  • Attends Interdisciplinary team meeting at the SNF for United members only
  • Collaborates with the facility staff in assessing the skilled needs of the member
  • Establishes the discharge date for the member to facilitate the issuance of the NOMNC in a safe and efficient manner to return the member to appropriate level of care
  • Assists the APC in rounds to ensure pertinent information is provided to the APC regarding skilled needs and discharge plans
  • Documents skilled needs and all staff communication in the EMR
  • Assists in the collection of HEDIS / Star measures information and documents in the EMR
  • Assess the medical necessity / effectiveness of ancillary services to determine the appropriate continuation of benefit events and communicate the process to providers and appropriate team members
  • Communicates to the Optum Utilization Management team, regulatory information regarding the DENC verbiage, DNOD information, and appeals information
  • Evaluate the effectiveness, necessity and efficiency of the discharge plan, making revisions as needed
  • Role may be telephonic or onsite
Care Coordination:
  • Understand the Payer / Plan benefits, CCM associate policies, procedures and TTS model of care and articulate them effectively to providers, members and key decision-makers as needed
  • Coordinate care as member’s transition through different levels of care and care settings
  • Monitor and communicate to APC plan of care for cost effectiveness while meeting the needs of members, families and providers to decreases high costs, poor outcomes and unnecessary hospitalizations.
Program Enhancement Expected Behaviors:
  • Regular and effective communication with internal and external parties including physicians, members, key decision-makers, nursing facilities, CCM staff and other provider groups
  • Actively promote the CCM program in assigned facilities by collaborating with key stakeholders (i.e.: internal sales function, provider relations, facility leader) to maintain and develop membership growth
  • Exhibits original thinking and creativity in the development of new and improved methods and approaches to concerns / issues
  • Function independently and responsibly with minimal need for supervision
  • Demonstrate initiative in achieving individual, team and organizational goals and objectives
  • Participate in CCM quality initiatives 

Job Case Management
Primary Location US-NC-Raleigh
Other Location US-OH-Canton, US-FL-Tampa, US-AZ-Phoenix
Organization Complex Care Management
Schedule Full-time
Number of Openings 4
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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