Emergency Department RN Case Manager - 5k Sign-On Bonus For External Candidates - Boulder, CO
Location: Boulder, Colorado
Internal Number: 109516193
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The Emergency Department RN Case Manager (CM) 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 for and reported as appropriate.
Adheres to name badge/dress code compliance.
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. Facilitates the implementation of nursing interventions as indicated by the multi-disciplinary team plan of care that enhances and compliments the skill level of the nursing staff.
Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity. Arranges schedule to facilitate meeting with physicians for patient care rounds, team meetings and other opportunities to improve communication.
Knowledge of all applicable federal and state regulations. Demonstrates a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care.
Consults with physician section leaders for support in cases that continued stay is not appropriate, and case manager is unable to come to resolution by working with assigned physician.
Responsible for communicating with the department director LOS and financial information, as well as issues that may affect the Continuum of Care process.
Continuum of Care Planning
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 insures 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 next level of care in the treatment plan as early as possible to promote continuity and collaboration.
Reports all relevant information to the staff assuming responsibility in the next level of care.
Employees are expected to comply with all regulatory requirements, including CMS and Joint Commission Standards.
Interface with department directors, Risk Management and patient representatives to identify potential QA or risk issues. Perform any necessary investigation, documentation and follow-up as required.
Participates in departmental SQI projects.
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.
Ability to effectively read, write, and speak, cognitively process and emotionally support performing other duties as assigned
All employees are expected to remain flexible to meet the needs of the hospital, which may include floating to other departments to assist as the patient needs fluctuate
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.
Current Colorado RN license in good standing
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
Case Management Certification
3+ years of recent clinical or case management experience in area of specialization
Clinical or Case Management experience in an Emergency Department
Knowledge/understanding of community resources, policies, and procedures
Clinical knowledge of the Labor and Delivery, Orthopedic, Neurology, Medical Surgical, Oncology, ICU patient and process
Ability to compile, evaluate and report statistics to members of the team, and utilize the information to facilitate process improvement activities. Strong communication skills are necessary for meeting facilitation, educational presentations, team collaboration and patient interviews
Solid analytical, critical thinking and organizational skills
SUPERVISORY DUTIES Takes lead role in directing disposition of patients and utilization considerations. Assumes leadership role to facilitate interdisciplinary collaboration.
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
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Colorado Residents Only: The salary range for Colorado residents is $54,400 to $97,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.
**PLEASE NOTE** The Sign-On Bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a Sign On Bonus.
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.