For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) 

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California, to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Under the direction of a registered Nurse, this position is responsible for 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 basic 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.  Reports findings to the Care Management department Supervisor / Manager / Director in a timely manner.

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
• Implements current policies and procedures set by the Care Management department
• Conducts on-site or telephonic prospective, concurrent and retrospective review of active patient care, including out-of-area and transplant
• Reviews patients’ clinical records of acute inpatient assignment within 24 hours of notification
• Reviews patients’ clinical records within 48 hours of SNF admission
• Reviews patient referrals within the specified care management policy timeframe (Type and Timeline Policy)
• Coordinates treatment plans and discharge expectations.  Discusses DPA and DNR status with attending physician when applicable
• Prioritizes patient care needs.  Meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan
• Acts as patient care liaison and initiates pre-admission discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement or home health follow-up
• 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 provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care
• Communicates authorization or denial of services to appropriate parties.  Communication may include patient (or agent), attending/referring physician, facility administration and Optum claims as necessary
• Attends all assigned Care Management Committee meetings and reports on patient status a defined by the region
• Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOR), and Bed Days
• Ensures appropriate utilization of medical facilities and services within the parameters of the patients’ benefits and/or CMC decisions.  This includes appropriate and timely movement of patients through the various levels of care
• Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients and families
• Provides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other related issues
• Initiates data entry into IS systems of all patients within the parameters of Care Management policies and procedures.  Maintains accurate and complete documentation of care rendered including LOC, CPT code, ICD-9, referral type, date, etc.
• Follows patients on ambulatory care management programs, including CHF and home health, in order to optimize clinical outcomes
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in 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: 

• Graduation from an accredited Licensed Vocational Nurse program
• Current LVN license in California
• 1+ years of recent clinical experience working as an LVN/LPN
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications: 

• 3+ years of clinical experience working as an LVN/LPN
• 2+ years of care management, utilization review or discharge planning experience
• Experience in an HMO or experience in a Managed Care setting

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, 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 at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)  

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians. 

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.  

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