Manager Optum Utilization Review Jobs in Rochester, NY

Department:PALLIATIVE CARE NURSING - Monroe County

Location: Rochester Regional Health Home Care - Monroe Ave

Hours Per Week: 40

Schedule: Monday - Friday, 8:30am-5:00pm

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

• Shift differentials to reward your flexibility

• 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

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.

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.

REQUIRED QUALIFICATIONS

• Diploma or Associate's Degree in Nursing

• Registered Nurse license in New York State

PREFERRED QUALIFICATIONS

• 1 year of nursing experience

• Prior home health, clinical and direct patient care experience