Case Manager - Per Diem

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth.

About the role

The Case Manager 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. Discharge planning will begin at the time of (or prior to) admission, and reassessed ongoing throughout the course of hospitalization. Quality and Risk Management issues will also be monitored and reported as appropriate. CM may be assigned to various units throughout the hospital or the Emergency Department.

Qualified candidates must live in the Boulder CO regional area and be willing to work onsite at a hospital facility (not a remote work-from-home position).

Schedule

• Required to work one weekend shift every two weeks
• Other days as needed

Responsibilities

• Integrate the assessment of the need for post-hospital services and determine an appropriate discharge plan for complex cases
• Educate patient/family as to options/choices within the level of care determined to be appropriate; initiate and ensure completion of all necessary paperwork
• Facilitate 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
• Emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists, and case managers from contracted payors to determine a 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
• Report all relevant information to the staff assuming responsibility in the next level of care
• Comply with all regulatory requirements, including CMS and Joint Commission Standards
• Demonstrate a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care
• Consult with physician section leaders for support in cases where continued stay is not appropriate, and case managers are unable to come to resolution by working with assigned physician
• Communicate with the department director regarding LOS and financial information, as well as issues that may affect the Continuum of Care process
• Review the patient plan of care with the multi-disciplinary team; facilitate and participate in multi-disciplinary team care conferences for patients with complex problems; communicate 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
• Coordinate patient care processes to achieve desired quality outcomes and identify/control inappropriate resource utilization
• Facilitate patient and family education and promote continuity of care to achieve optimal patient outcomes; assure patient rights by offering a choice when appropriate

Professional Accountabilities

• Adhere to name badge/dress code compliance
• Effectively solve problems and actively pursue resolution
• Directly communicate with staff, physicians, patients, and families in a professional and courteous manner
• Role model leadership behavior through courtesy, respect, and efficiency
• Function without direct supervision, utilizing time constructively and organizing assignments for maximum productivity; arrange schedule to facilitate meeting with physicians for patient care rounds, team meetings, and other opportunities to improve communication

Requirements

• Registered Nurse (RN) with a current, active, unrestricted RN License in Colorado OR a Social Worker (either a Licensed Clinical Social Worker [LCSW] in Colorado or Master of Social Work [MSW] will qualify)
• 2+ years of experience working as a clinician in an acute care setting with proficient knowledge of hospital workflows
• Live in the Boulder CO regional area (this position is location-based and not open to remote work)
• Willing/able to work one weekend shift per two weeks and availability as needed

Preferred Qualifications

• Case management experience or certification
• Knowledge or understanding of community resources, policies, and procedures
• Solid clinical acumen with the ability to use sound judgment, deductive reasoning, and problem-solving skills
• High level of organization with the ability to stay focused on the detail
• Collaborative skills and ability to interact with people of diverse backgrounds
• Solid written and verbal communication skills
• Self-motivated and able to function in a fast-paced work environment
• Meets and maintains quality and productivity standards
• Solid working knowledge of Microsoft packages
• Ability to learn and understand various clinical software applications
• Proficient typing skills
• Critical thinking and organizational skills

Pay

The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)