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RN Case Manager-Field Based - Offering $3k SIGN-ON! Irvine, CA

UnitedHealth Group

Irvine, CA
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Job Details

RN Case Manager-Field Based - Offering $3k SIGN-ON! Irvine, CA(Job Number:725153)

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)
Schedule: Monday - Friday 8am - 5pm
*This position will travel 90% of the time in South Orange County to designated Nursing Homes and Long Term Care locations.  The remaining 10% will be in the office in Irvine, CA.     

Primary Responsibilities:
  • Performs concurrent and retrospective onsite or telephonic clinical review at the designated network or out - of - network facilities as needed / directed by the Post - Acute Management team (Director, Manager, and Supervisors) documenting medical necessity and appropriate level of care utilizing clinical guidelines (e.g. Milliman, Interqual). Complies with CMS regulations and Health Plan requirements
  • Coordinates services and referrals to health programs
  • Identifies problems or gaps in care offering opportunity for intervention
  • Assists members in sorting through their benefits and making choices
  • Interacts and effectively communicates with members, their families and / or designated member representative to assess discharge needs and formulate discharge plan, provide Health Plan benefit information, and services available based on clinical need
  • Interacts daily with treating physicians regarding the Monarch HealthCare member's plan of care and alternative care solutions. Consults the Monarch Medical Director / designee for unusual and complex cases
  • Effectively communicates plan of care to facility staff, health plan partners, and Ambulatory Case Management (ACM) to ensure understanding treatment plan and clinical needs at time of transition to lower level of care
  • Documents and maintains a Continuity Plan of Care for the Monarch HealthCare member by assessing and identifying continued needs upon discharge to encompass; health services, durable medical equipment, hospice, follow - up physician appointments, skilled versus sub - acute versus custodial levels of care

Job Case Management
Primary Location US-CA-Irvine
Other Location 
Organization Monarch
Schedule Full-time
Number of Openings 1
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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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