Optum Utilization Review Jobs (NOW HIRING)

$2,500 Sign-on Bonus for LPN External Candidates / $5,000 Sign-on Bonus for RN External Candidates

Optum FL is seeking a Case Manager to join our team in Oviedo, FL. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Position in this function is responsible for ensuring the continuity of care in both the inpatient and outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients' health plan benefits. Facilitates continuum of patients' care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes.  Performs care management functions on-site or telephonically as the need arises.  Works in conjunction with the care team and PCP as care team leader.  Ensures evaluation is in alignment with site based goals.

Primary Responsibilities:

• Prioritizes patient care needs upon initial visit and addresses emerging issues
• Meets with patients, patients' family and caregivers as needed to discuss care and treatment plan as delineated in Transitions of Care program
• Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings
• Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes
• Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care
• Maintains effective communication with the physicians, disease management, hospitalists, extended care facilities, patients and families
• Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports

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.

Required Qualifications:

• High school graduate, GED or equivalent
• State Licensed LPN or RN
• Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross) or be able to obtain within 90 days of employment
• Additional Requirements for LPNs:
  • Certificate in Practical Nursing
  • Valid Florida LPN license
  • IV certification or the ability to obtain within 90 days of employment
• Additional Requirements for RNs:
  • Associates or Bachelor's degree in Science
  • Valid Florida RN license

Preferred Qualifications:

• 1 years of experience in an acute clinical care setting
• Care management, utilization review or discharge planning experience
• HMO experience
• Ability to read, write and speak the Spanish language fluently

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.