Care Manager - Apopka Clinic at E. Semoran

Sign on Bonus for External Candidates

$2,500 Sign On Bonus for LPNs/ $5,000 Sign On Bonus

Optum FL is seeking a LPN or RN to join our team in Apopka, FL. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

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 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 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
• 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)
• Work collaboratively with the provider and care team to carry out nursing interventions under proper scope of practice
• Performs additional duties as assigned
• 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, GED or equivalent
• Graduation from an accredited school of Nursing
• Possess a current and valid LPN or RN Florida state license
  
  
  
  • RNs: Associate's or bachelor's degree in Science
  • LPNs: IV Certification
  
  
  
  
• Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross) or ability to obtain within 90 days of employment
• Experience in an acute clinical care setting or equivalent
• Care management, utilization review or discharge planning experience
• Knowledge of HIPAA regulations
• Proven ability to explain medical instructions to patients and their families
• Proven ability to read, speak, write, and understand the English language fluently

Preferred Qualifications:

• 1+ years of experience in an acute clinical care setting
• HMO experience
• Proven ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff
• Proven ability to communicate effectively with patients and all levels of personnel/customers in a professional, courteous and effective manner using excellent customer service skills
• Proven ability to make sound, independent judgments and act professionally under pressure
• Proven ability to prioritize and multi- task in a high paced environment with good organizational skills
• Proven to display initiative, accountability and resourcefulness
• Bilingual English/ Spanish

If the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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