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)

Responsible for utilizing the appropriate resources while working closely with physicians, specialists, care managers, and facility nurses or representative to coordinate patient’s transition to contracted facility or next level of care within the parameters of established contracts and patient’s health plan benefits. Performs job functions telephonically or at on-site office as the need arises. Reports findings to the department management team in a timely manner.

*Remote position, not accepting out of state candidates. Local candidate considered of LA County, Orange County, and South Bay areas.*

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
• Coordinates ED repatriations, safe transfers, and discharge instructions as directed and approved by the regional hospitalists and/or on-call hospitalists; or as tasked by regional inpatient teams
• Delegates provisions for discharge including follow-up appointments, home health, social services, transportation to care coordinators to ensure appropriate and timely movement of patients through the various levels of care
• Diligent in obtaining additional clinical information or overcoming lack of transportation from hospital to home in order to prevent delay in discharge or transfer
• Consistently and accurately completes documentation for any post stabilization requests, MD to MD determination and level of care decision
• Approves medically appropriate referrals within required regulatory timeframes in order to facilitate safe discharges or transfers
• Ensures appropriate utilization of medical facilities and services within the parameters of the patients’ benefits
• Maintains effective communication with the physicians, hospitals, extended care facilities, and when necessary patients and families
• Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of Division of Financial Responsibility (DOFR)
• Communicates authorization or denial of services to appropriate parties and may include patient (or agent), attending / referring physician or facility administration
• Reviews expedited appeal notifications, prepares and sends appeal packets with requested information to Livanta and health plans within timeframes outlined
• Writes Detailed Notice of Discharge (DND) and Detailed Explanation of Non-Coverage (DENC) to include in Livanta appeal packets
• Reviews appeal decisions received from Livanta and health plans, updates referral management system and provides evidence to health plans as requested
• Refers patient for PDV appointment immediately after discharging/leaving AMA from Emergency department to home
• Responsible to track team caseloads, completes staffing schedule, and escalates issues to management as needed
• Seeks and identifies opportunities for process improvement
• Expected to participate in weekend and holiday coverage rotation per business needs
• Meets or exceeds productivity targets
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Performs additional duties as assigned
  

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:

• Graduate of a state-approved school of professional LVN/LPN nursing
• Current, unrestricted California LVN License
• 1+ years of experience in a healthcare setting
  

Preferred Qualifications:

• Discharge planning experience
• HMO / Managed Care experience
  

Knowledge, Skills, Abilities:

• Computer literate.
• Ability to work with multiple computer platforms simultaneously
• Knowledge of current standards of patient care
• Thorough understanding of LVN scope of practice
• Manual dexterity to use and handle equipment and instruments
• Ability to effectively communicate and collaborate with physicians, patients, families and ancillary staff
• Ability to make sound, independent judgments and act professionally under pressure
• Demonstrates effective documentation and verbal communication skills: factual, accurate, clear and timely to support delivery of effective patient care interventions and collaborative management
  

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.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $18.80 to $36.78. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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.