RN Case Manager Field Based Home Care Northeast PA
- Scranton, PA
Serving millions of Medicare and Medicaid patients, Optum is the nation's largest health and wellness business and a vibrant, growing member of the UnitedHealth Group family. We're also the career home for Registered Nurses who bring compassion and passion, energy and focus to their work every day. As a Home Visit Registered Nurse with Optum, you'll provide primary care home visits for patients in collaboration with the physician of record and patient care team. This position is serving throughout the Northeastern Pennsylvania area.
The Optum Dual Special Needs Plan (DSNP) at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The DSNP program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the Optum clinician, the member's Primary Care Provider and other providers, and other professionals.
The Field Registered Nurse supports the overall patient care management process for members in In-Home DSNP program. The Field Registered Nurse provides oversight, guidance and support for the patient care plan as developed in collaboration with the interdisciplinary care team along with the health plan and additional heath care vendors to meet the needs of the patient. The Field RN coordinates and provides appropriate levels of care under the direct supervision of an RN/APC or MD. This position is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, in home visit assessments, coordination of care, and medical management consulting. The Field RN will also be responsible for home visits, transition of care management, providing health education, coaching and treatment decision support for members in At Home DSNP program.
- Perform initial review of consumer health records and current health status (e.g., health risk scores) to identify health risk and determine next steps
- Conduct initial and ongoing assessments utilizing nursing assessment skills in home setting
- Receive information from consumers about specific symptoms and questions
- Conduct interviews to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
- Evaluate consumer data throughout the assessment process to identify inconsistencies and adherence to Evidence Based Guidelines from both the health care and psychosocial / socioeconomic dimensions of care
- Identify and prioritize gaps to develop plan of care and short and long term goals to empower consumers to meet identified goals
- Determine consumer's willingness to engage in plan of care and readiness for change
- Identify appropriate interventions and resources to meet gaps (e.g., psychosocial, transportation, long-term care) based on specific consumer needs from both the health care and psychosocial / socioeconomic dimensions of care
- Document the plan of care in appropriate EHR systems and enter data per specified format
- Maintain consumer engagement by establishing rapport, demonstrating empathy, and building a trusting relationship
- Collaborate with primary providers or multidisciplinary team to align or integrate goals to plan of care and drive consistent coordination of care
- Provide ongoing support for advanced care planning.
- Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals
- Understand and operate effectively / efficiently within legal/regulatory requirements
- Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business results
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.
- Active, un - encumbered RN license to practice nursing in the state of assignment or ability to obtain
- Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area
- Undergraduate degree or equivalent experience
- Effectively communicate with elderly and chronically ill patients and families
- Bi - lingual or multi - lingual
- Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial
- Comfortable working independently in a home - visit setting
- Basic knowledge of computers and cell phones
- Excellent organizational skills with the ability to multi-task and manage schedule
- Excellent Collaboration skills and ability to communicate with care team and physicians
- Experience working with complex patient populations including multiple chronic diseases with diverse psychosocial backgrounds
- Previous experience working in home health or in home setting
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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.
Keywords: RN, Case Management, Scranton, Wilkes Barre, Susquehanna, Wayne, Pennsylvania, PA
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