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. Our team is focused on achieving wellness for the most socially, medically, and behaviorally complex individuals with sensitivity to the impact of social determinants of health. Our commitment to innovation generates new ideas with a distinctive focus on driving impactful change and improved patient outcomes within the communities we serve. RN Discharge Case Manager: This role will help create and define a new standard of patient-focused discharge care. Working collaboratively in a cross-functional team, the Discharge Care Manager (DCM) will lead comprehensive care coordination for members while they are in the acute inpatient hospital setting and throughout the 30 days following an inpatient stay. With a focus on validated learning, the DCM will propose refinements to the care model and serve as a subject matter expert to inform and implement broader adaptations of the care model in adjacent communities and other locations nationally. Discharge care coordination entails working with the following roles: members, primary care providers, acute inpatient care managers and leadership, Medical Director team, Network team, alternate level of care teams, social workers, behavioral health advocates, facility discharge planners, ancillary providers, community health workers, and other internal and external member support programs. The discharge care manager (DCM) role is critical to ensuring the member has a safe discharge to home or other setting and to support readmission reduction in accordance with regulatory standards.Primary Responsibilities: By obtaining patient feedback, monitoring behavior and analyzing outcomes, the DCM will play a pivotal role that improves individualized patient care. The DCM will coordinate and document the discharge plan in collaboration with other key clinical care team members. The DCM will follow the member while in the acute inpatient setting and in the 30-day post discharge period. Responsibilities will include, but are not limited to:Evaluation of member discharge needs including delays in care and readmission prevention plan Collaboration with providers and members to coordinate care, including onsite or telephonic visits in the inpatient setting and telephonic outreach in 30-day post discharge period Participate in regular, cross-functional team meetings to share patient feedback and care model synthesis Assist in care model refinement embracing a collaborative build-measure-learn perspective of continuous improvement Provide insights and feedback to inform broader expansion of the discharge care model Train and coach nursing staff to replicate and apply care model protocol and techniques Participate in rounds with the Medical Director to discuss cases as needed Identification of internal or community based program support or resources Coordination with the facility Discharge Care Coordinator to ensure post hospital services are arranged prior to the member being discharged Assist with coordination of difficult cases needing placement in an alternate level of care facility Referral to Social Worker and other internal resources for assistance when needed Documentation of discharge activities as outlined in standard operating procedures and data entry strategies Participate in team meetings, education discussions and related activities Works collaboratively with team members in a matrix environment to ensure an end to end positive experience for members, providers and care teams Conduct medication review and reconciliation
Required Qualifications:A current, unrestricted Florida RN license Residency in the state of Florida Commutable distance to Orlando, Florida 2 + years' experience of case management and/or discharge planning Ability to travel domestically up to 25% Comfortable working within the context of a startup/entrepreneurial environment Ability to train and coach nursing staff on care model techniques as appropriate Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others Ability to build and maintain relationships will be essential Proficiency in typing skills and software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint and Microsoft Outlook Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of actionPreferred Qualifications:A Bachelor of Science in Nursing A case management certification Experience implementing new care model practices Experience working with multiple health insurance products (i.e. Medicaid, Medicare, Commercial) within the insurance industry, including regulatory and compliance requirements (Experience with Medicaid) Minimum of 3-5 years total experience in the inpatient acute setting Understanding of MCG Guidelines or other nationally recognized practice guidelines Bilingual (Spanish and English)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. Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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: Discharge, Medicaid, Medicare, Acute Care, hospital, CCM, MCG, bilingual, Spanish, clinical, nursing, Orlando, FL, Florida
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.