Per Diem Case Manager RN

Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together.

The Case Manager RN is responsible and accountable for coordination of patient services through an interdisciplinary process, which provides a clinical and psychosocial approach through the continuum of care.  Through concurrent case management, patients will be assessed to determine appropriateness of admission, continued hospitalization, as well as appropriate level of care. Case Managers facilitate timely care delivery at the right time, in the right setting, by following CMS guidelines, escalation of operational barriers, and collaboration with all stakeholders. Discharge planning will begin at the time of (or prior to) admission, and reassessed ongoing throughout the course of hospitalization in partnership with the clinical team, the patient, and / or the patient's representative. Quality and Risk Management issues will also be monitored and reported as appropriate.

Locations :  You will be asked to support any of the following locations :

Waukesha Memorial Hospital - 725 American Ave, Waukesha, WI

Oconomowoc Memorial Hospital 791 Summit Ave. Oconomowoc WI 53066

Mukwonago Hospital 240 Maple Ave Mukwonago WI 53149

Schedule :  As needed / Per Diem, required to work 1 weekend a month

Training : We offer 2 weeks of paid training M-F standard business hours

Primary Responsibilities :

Takes lead role in directing disposition of patients and utilization considerations

Assumes leadership role to facilitate interdisciplinary collaboration

Effectively problem-solves and actively pursues resolution

Directly communicates with staff, physicians, patients and families

Role models leadership behavior through courtesy, respect and efficiency

Coordinates patient care processes to achieve desired quality outcomes and identifies / controls inappropriate resource utilization

Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes. Assures patient rights by offering a choice when appropriate

Reviews the patient plan of care with the multi-disciplinary team. Facilitates and participates in multi-disciplinary team care conferences for patients with complex problems. Communicates in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care

Daily communication and collaboration with the patient care staff to provide continuous assessment, evaluation, and continuum planning to assure the patient receives the appropriate level of care at the appropriate time

Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity. Arranges schedules to facilitate meetings with physicians for patient care rounds, team meetings and other opportunities to improve communication

Ability to effectively read, write, and speak, cognitively process and emotionally support performing other duties as assigned

Basic Microsoft Office Skills

All employees are expected to remain flexible to meet the needs of the hospital, which may include floating to other departments to assist as patient needs fluctuate

Must be able to functionally coordinate and discharge plan for all age groups, including but not limited to the unborn child through geriatric age groups

The CM will be responsible for integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases

Educates patient / family as to options / choices within the level of care determined to be appropriate. Initiates and ensures completion of all necessary paperwork

Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed

Continuum of Care planning will emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists, and case managers from contracted payors when appropriate to determine discharge plan that will be of maximum benefit to the patient. Involve staff from the next level of care in the treatment plan as early as possible to promote continuity and collaboration

Develop care plans for patients who frequent the Emergency Department in partnership with the patient's physician, ED Provider, and community resources

Knowledge of all applicable federal and state regulations. Shows working knowledge of managed care and Medicare health plans and reimbursement related to post-acute services within the continuum of care

Reports all relevant information to the staff assuming responsibility in the next level of care

Responsible for communicating with the department director LOS and financial information, and issues that may affect the continuum of care process

Adheres to name badge / dress code compliance

What are the reasons to consider working for UnitedHealth Group?  Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include :

Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays

Medical Plan options along with participation in a Health Spending Account or a Health Saving account

Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage

401(k) Savings Plan, Employee Stock Purchase Plan

Education Reimbursement

Employee Discounts

Employee Assistance Program

Employee Referral Bonus Program

Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

More information can be downloaded at :  http : / / uhg.hr / uhgbenefits

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 :

Associate's Degree (or higher) in Nursing

Current, unrestricted RN license in the state of employment

3+ years of experience working in a hospital and inpatient medical / surgical unit

3+ years of experience working with inpatient hospital case management

3+ years of experience with / knowledge of community resources, policies and procedures

3+ years of clinical experience with / knowledge of age groups, including but not limited to the unborn child through geriatric age group

Preferred Qualifications :

Bachelor of Science

Case Management Certification

Must have strong analytical, critical thinking and organizational skills

Knowledge of Utilization Review, Medicare Requirements processes as well as State and Federal regulations pertaining to Utilization Review and Discharge Planning

The salary range for this role is $28.61 to $56.06 per hour based on full-time employment. 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.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

#RPO #RED