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RN Case Manager - Skilled Nursing Facility - Irvine, CA

Employer
UnitedHealth Group
Location
Irvine, CA
Closing date
Jan 22, 2021

View more

Profession
Nurse
Specialty
Nursing
At Monarch HealthCare, an OptumCare Company, you will perform within an innovative culture focusing on transformational change in the health care system. You will leverage your skills across a diverse and multi - faceted business. Your contributions will have an impact greater than you have ever imagined! Join us and help people live healthier lives while doing your life's best work.(sm)

As a part of our continued growth, we are searching for an Utilization RN Case Manager to join our team.

If you are located in Irvine, CA, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Performs concurrent and retrospective telephonic clinical reviews at the designated network or out-of-network facilities
  • Documenting medical necessity and appropriate level of care utilizing clinical guidelines (Milliman)
  • Complies with CMS regulations and Health Plan requirements
  • Interacts and effectively communicates with members, their families and or designated member representative to assess discharge needs and formulate a discharge plan, provide Health Plan benefit information
  • Interacts daily with treating physicians regarding the Monarch HealthCare member's plan of care and alternative care solutions
  • Effectively communicates plan of care to facility staff, health plan partners, and ambulatory case management

Monday-Friday, 8:00 am-5:00 pm. *No nights, weekends or holidays.


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 Diploma or GED
  • Current and unrestricted California RN
  • 2+ years of experience in acute care clinical setting
  • 1+ years of case management experience
  • Microsoft Office - Word / Outlook
  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive VoiceResponse (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
  • You will be asked to perform this role in an office setting or other company location




Preferred Qualifications:
  • Experience working with Milliman and InterQual
  • Experience in utilization management
  • Certified Case Manager (CCM)
  • Skilled Nursing experience


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)




For more informationon our Internal Job Posting Policy, clickhere.

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: UM RN, Monarch, case management, RN Case Manager, case manager, hospital, acute care, telephonic, Monarch, Irvine, CA, California

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