Full Time Optum Health Utilization Review Jobs in Rochester, NY

SUMMARY

The RN Case Manager is responsible for the delivery of comprehensive nursing care to a set of assigned patients at a specific point in time. This involves the assessment of patient and family needs and the development, implementation and evaluation of an appropriate Plan of Care, making changes in response to changing patient needs. The RN Case Manager identifies appropriate interdisciplinary services needed, coordinates those services and supervises Private Duty Nurses (PDN) as applicable.

STATUS:Full-Time

LOCATION: Rochester Regional Health Home Care - Newark

DEPARTMENT: Homecare

SCHEDULE: Monday-Friday, 8:00am-4:00pm

Rochester Regional Health Home Care is the only home care provider in the region to earn a CMS 5-Star Quality of Patient Care rating, placing its CHHA among the top 3.5% of agencies nationwide. In addition, CHHA was recognized by U.S. News & World Report as a "High Performing Home Care Agency," further highlighting its commitment to exceptional patient care and clinical excellence.

Why Join Our Team?

• Set your own work schedule to fit your lifestyle and work-life balance

• Mileage reimbursement + paid drive time between patient visits

• Overtime opportunities for additional earning potential

• Up to $10,000 in tuition assistance for BSN to MSN advancement

• Tuition and student loan assistance programs to support your financial goals

• Comprehensive full benefits package

ATTRIBUTES

• Level I -1 year of nursing experienced preferred.
• Prior home health, clinical and direct patient care experience preferred.
• Ability to work independently.
• Demonstration of solid interpersonal, organizational and time management skills.
• Proficient computer skills.
• Must be able to document clinical notes and assessments within an electronic medical record.
• Ability to travel to and from required locations as needed to perform the essential responsibilities of the job.
• Level II - requires similar qualifications as level I, plus:
• Understands when to escalate to management.

RESPONSIBILITIES

• Identifies and prioritizes health problems based on assessment
• Develops or implements an interdisciplinary Plan of Care based on the needs identified during the assessment, with input from the patient (and their caregivers as applicable), in collaboration with the attending physician and other care team members
• Manages and coordinates patient care, including clinically complex cases, in a manner which ensures the efficient and effective delivery of appropriate services and community supports
• Exhibits proficiency and accuracy in the completion of comprehensive assessment/documentation, which may include assessments required by payer sources (e.g., Outcome and Assessment Information Set (OASIS), Hospice Item Set (HIS)).
• Plans, organizes and prioritizes care needs for an assigned caseload of patients to ensure their care needs are met and services are delivered according to plan of care
• Communicates all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner
• Facilitates the development and implementation of patient discharge plans as indicated
• Documents all patient care and coordinating activities per agency standards
• Assesses the need for additional services (aide, therapies, social work or a community service) and obtains orders and arranges care as indicated
• Supervises and evaluates care provided by Licensed Practical Nurses and/or home health aides in the performance of his/her patient care duties
• Works collaboratively with other care team members by communicating all changes in patient status and/or service needs to the appropriate care team member and ensures appropriate action is taken in a timely manner.
• Correctly identifies patient/family risk factors and establishes goals and interventions to reduce/remove risk from the plan of care to enable patients to remain in the least restrictive care setting.
• Coordinate/participate in interdisciplinary team meetings/patient care conferences.
• Patient needs are prioritized; visits outside primary team assignment or geographical area may be required in order to meet patient need.
• Practices according to Agency and community standards
• Participates in utilization review and/or continuous quality improvement activities as requested.
• Attends required staff meetings, in-services and/or supervisory conferences.
• Participates in on-call schedule and weekend/holiday schedule as assigned.
• Consistently demonstrates high standards of integrity by supporting the Rochester Regional Health Companies' mission and values and adhering to the Corporate Code of Conduct.
• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
• Regular and reliable attendance is expected and required.
• Performs other job-related duties as assigned by management.

REQUIRED QUALIFICATIONS

• Diploma or Associate's Degree in Nursing required
• Registered Nurse license in New York State.
• Valid NYS Driver's License.

PREFERRED QUALIFICATIONS

• Bachelor's Degree in Nursing preferred.

EDUCATION:

LICENSES / CERTIFICATIONS:

PHYSICAL REQUIREMENTS:

Drive - Clinical - Roles in this category require frequent driving combined with mobile clinical care across settings such as emergency response, mobile clinics, and home health environments. Staff must repeatedly enter and exit vehicles, occasionally lift and carry equipment weighing up to 100 lbs. or more, and perform care within patients' homes or other confined, unpredictable, or uncontrolled environments. These positions demand strong fine and gross motor control, firm grasping, and heightened visual and auditory awareness to ensure safe and effective care delivery. Emotional and cognitive demands are substantial due to rapid decisionmaking, direct exposure to critical or sensitive situations, and independently managing patient care in the field or home setting. Environmental exposures may include traffic hazards, infectious agents, extreme temperatures, variable home conditions, and hazardous materials. Valid licensure, physical readiness, and flexibility for extended or oncall schedules are typically required.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE:

$77,983.00 - $103,906.00Newark14513

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.