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Careers at UnitedHealth Group

 

We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM

 

Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com

 

Job Category:

Nurse

Country:

US

Postal Code:

46201

Approximate Salary:

Not Specified

Position Type:

Full Time

LPN - Inpatient Case Manager - Indianapolis, IN

UHG - Indianapolis, Indiana

Posted: 10/16/2018

At Optum, part of UnitedHealth Group, we want the health system to work better for everyone. Join us and you'll be part of a team that's focused on transformational change. As a Case Manager, you'll help provide a holistic, patient-centered approach to care that addresses both immediate and long-term needs. And you'll open doors for yourself that simply do not exist in any other organization, anywhere. Join us and feel proud knowing you're empowered to help people live healthier lives.

 

The Licensed Vocational Nurse (LVN) and/or Licensed Practical Nurse (LPN) Case Manager is responsible for utilization management and inpatient care management coordination in a telephonic and/or onsite care management position. The LVN/LPN Case Manager will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. The LVN/LPN Case Manager works under the direct supervision of an RN or MD. This role acts as a support to team members, coaching, guiding and providing feedback as necessary. This function is responsible for care management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). The LVN/LPN Case Manager, will act as an advocate for members and their families guide them through the Health Care system for transition planning. The function may also be responsible for providing health education, coaching and treatment decision support for members and will participate in interdisciplinary care conferences.

 

Primary Responsibilities:

  • The LVN/LPN Case Manager serves as the clinical liaison with hospital clinical and administrative staff as well as providing expertise for clinical authorizations for inpatient care
  • Makes outbound calls to assess members' current health status
  • Performs case reviews telephonically and/or onsite for assigned inpatient facilities and skilled nursing facilities. Advises supervisor of any potential problems as they become evident
  • Ensures that our members receive the proper levels of care based on evidence-based criteria and assesses and interprets needs and requirements, in addition to referring patients to disease or case management programs. Makes transition discharge follow up calls to ensure that discharged member receive the necessary services and resources according to their transition plan
  • Conduct Utilization Reviews (concurrent, standard and retrospective reviews) using approved health plan guidelines such as Milliman Criteria and/or InterQual Criteria
  • Demonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning activities
  • Track ongoing status of all certification activity and maintain continuing certification (or denial)
  • Makes telephonic/onsite assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, members, and providers
  • Adhere to quality standards and state UR guidelines, as well as confidentiality of all information, policies, and procedures. Adheres to company policies, procedures, and reporting requirements
  • Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
  • Performs all other related duties as assigned
  • Identify and refer all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Compliance Department

Required Qualifications:

  • Associate’s degree in Nursing combined with 2+ years of experience
  • Current, unrestricted LVN/LPN license, specific to the state of employment
  • 2+ years of managed care and/or case management experience
  • 3+ years of clinical experience
  • Knowledge of managed care, medical terminology, referral process, claims and ICD-10 codes
  • Skills in planning, organizing, conflict resolution, negotiation and interpersonal skills to work with autonomy in meeting UM goals
  • Knowledge of utilization management and/or insurance review processes as well as current standards of care, a strong knowledge of health care delivery systems and the ability to interact with medical directors, physician advisors, clinicians and support staff
  • The ability to work independently in accomplishing assignments, program goals and objectives
  • Case Management Certification within 1 year of employment under the supervisory of a Certified Case Manager

Preferred Qualifications:

  • Case Management certification
  • Proficient computer skills in Microsoft applications
  • Excellent verbal and written skills

Physical and Mental Requirements:

  • Ability to lift up to 50 pounds
  • Ability to push or pull heavy objects using up to 25 pounds of force
  • Ability to sit for extended periods of time
  • Ability to stand for extended periods of time
  • Ability to use fine motor skills to operate office equipment and/or machinery
  • Ability to receive and comprehend instructions verbally and/or in writing
  • Ability to use logical reasoning for simple and complex problem solving

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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.

 

 

Jo Keywords: Case Manager, LVN, LPN, RN, Nurse, Nursing, Clinical, WellMed, Indianapolis, IN, Indiana

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