North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform. The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets. This position is to support the Network Inpatient Initiatives to improve our member's transition and outcomes throughout the inpatient care process. 2 Schedule Options: Wednesday-Sunday. Wed-Fri: 8:30-5pm In office- Sat/Sun: Telecommute flexible hours, but must work 8 daytime hours, ex. 10am-6pm. OR Monday-Friday 8am-5pm Primary Responsibilities:Provide shift based 24/7/365 clinical and care coordination support to the institutional care program (ICP) Work with ER and Hospitalist teams to provide clinical intel to the point of care Work with care coordination teams to ensure timely and safe discharge as evidenced by a reduction in inappropriate readmissions Support clinical record review and adherence to clinical coverage criteria with access to EMR records Audit adherence to coverage criteria in close coordination with Medical Director Engage in, and support focused education driven by identification of practice variation Provide weekend telephonic and support UM and discharge planning needs of our member in the acute setting to a lower level of care Cover staff on PTO in the field (acute hospital)
Required Qualifications:CA Licensed RN or LVN 1 + years of managed care experience 1+ years of case management experience 2+ years of experience in an Acute Hospital setting (Med / Surg, Tele, ICU) or like setting Willingness to work at various job sites dependent on Network needs and weekends Strong computer skillsPreferred Qualifications:Willing to take on Manager / Supervisor duties when needed Strong understanding of disease process / managementCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)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: Utilization management, case manager, LVN, RN, managed care, acute hospital, Ontario, CA, California
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.