Optum is seeking a Nurse Case Manager to join our Home-based Medical Care team in Albany, NY. Optum is a clinician-led care organization, that is creating a seamless health journey for patients across the care continuum.
As a member of the broader Home and Community Care team, you'll help bring home-based medical care to complex, chronic patients. This life-changing work helps give older adults more days at home.
At Optum, the integrated medical teams who practice within Home and Community Care are creating something new in health care. Together, we are bringing high-end medical service, compassionate care and industry leading solutions to our most vulnerable patient populations. Our holistic approach addresses the physical, mental and social needs of our patients wherever they may be - helping patients access and navigate care anytime and anywhere. We're connecting care to create a seamless health journey for patients across care settings. Join our team, it's your chance to improve the lives of millions while Caring. Connecting. Growing together.
The Nurse Care Manager (NCM), is an integral part of the Interdisciplinary care team (IDT), and is responsible for the overall care management process for high acuity engaged patients. The NCM has oversight for developing, managing, and coordinating patients' plan of care to include medical and psychosocial needs and patient-centered goals. The NCM works with patients/caregivers to maintain and improve health status by providing care coordination, health education, guidance and support for medical and psychosocial complex chronic conditions. Professionals in this role elicit input from the IDT based on initial and ongoing comprehensive assessments of the patient.
The NCM uses nursing assessment, evaluation skills, data and reports to guide care planning decisions for the patient. They are skilled at navigating the patients' health plan benefits to identify providers, resources and vendors that provide required care and services. The NCM works collaboratively with the IDT to provide appropriate, effective, high quality, and cost-effective care to engaged patients in their current residence. If a patient requires care outside their residence, the NCM collaborates with community-based service providers to ensure coordinated care during critical times of transition between health care settings and home.
In addition to the NCM, the HbMC IDT includes but not limited to, physicians, nurse practitioners, physician assistants, nurse care managers, behavioral health clinicians, social workers, pharmacists, dietitian/nutritionists, ambassadors, care coordinators, the patient and/or caregiver and family.
If you are located in Albany, NY, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Acts as an advocate for the patient
- Engages and collaborates with patient/caregiver and providers to develop an individualized Care Plan that addresses disease management, health promotion, and patient-centered goals
- Monitors patient progress against Care Plan goals with an emphasis on patient care needs during times of transition in care setting and changes in health status
- Identifies barriers to achieving Care Plan goals and collaborates with patient/caregiver as well as IDT to overcome barriers to success
- Understands and adheres to regulatory timeframes and standards required by National Committee for Quality Assurance (NCQA) within a Delegated Case Management market and Dual & Chronic Special Needs Plans (SNP)
- Provides disease management, health promotion and prevention education to patients/caregivers and/or family patients to manage disease progression and encourage proper medical testing, so patient can remain as independent as possible
- Completes initial and ongoing patient assessment, using information gathered from patient/caregiver/family, providers, HbMC EMR, and available medical records
- Manages and coordinates care and services within an Interdisciplinary Team
- Manages incoming clinical calls to ensure patients' medical concerns are addressed by the care team in a timely manner
- Participates in and documents advance directive conversations with patient/caregiver and/or family, and collaborates to reconcile patient/caregiver goals with the current clinical status
- Coordinates care needs across the continuum of care and is the point of contact for patient/caregiver and clinicians
- Leads daily IDT Huddle
- Actively participates in HbMC meetings and education sessions
- Acts as liaison between providers, nursing facilities, hospitals and program staff, including making recommendations about care alternatives
- Facilitates/coordinates admission to a recommended level of care on a temporary or permanent basis
- Promotes patient safety. Reviews or initiates a home safety, functional assessment, and/or falls risk assessment with home-based providers to determine need for adaptive equipment. Assists with acquisition of assistive equipment, as recommended
- Monitors patient during admissions and provides nursing/assisted living facility and provider training on HbMC program philosophy and approach to patient care
- Supports patients during transitions of care through assessment, coordination of care, education of the plan of care and evaluation of the effectiveness of the plan
- Identifies and reports any potential quality-of-care issues to Clinical Supervisor/HSD, so a plan of improvement can be developed and implemented, as needed
- At times, the NCM may visit a patient in their home for education or assessment, Market/State dependent
- Maintains HIPAA compliance at all times
Supervisory:
- Reports directly to the Health Services Manager
Competencies:
- Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully utilizing critical thinking skills; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics
- Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments
- Interpersonal Skills - Focuses on solving conflict; maintains confidentiality; listens to others; keeps emotions under control and overcomes resistance when necessary; remains open to new ideas
- Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and seeks clarification; responds openly to questions. Must be able to deal with frequent change, delays, or unexpected events
- Attendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time
- Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commits to long hours of work when necessary to reach goals; completes tasks on time or notifies appropriate person with an alternate plan
- Initiative - Volunteers readily; undertakes self-development activities; seeks increased responsibilities; takes independent actions and calculated risks; looks for and takes advantage of opportunities; asks for and offers help when needed; generates suggestions for improving work and workflow
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:
- New York state nursing license required
- RN License must be current, active, unrestricted and unencumbered
- 3+ years of clinical practice in a hospital, home care, hospice, clinic, or nursing home setting
- Electronic Medical Record documentation experience
- Proficient in patient-centered Care Plan creation and active management
- Computer skills: internet navigation, Microsoft Office - Outlook, Word and Excel
Preferred Qualifications:
- BSN
- Case Management experience and CCM Certification
- 1+ years of Utilization Management experience
- Disease state management experience with solid ability to educate patients on health and wellness
- Population Health management experience
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
New York Residents Only: The salary range for this role is $58,300 to $114,300 annually. 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.
Diversity creates a healthier atmosphere: OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.