Remote Optum Utilization Review Jobs in Oklahoma

WHO WE ARE:
GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
WHO YOU ARE:
This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care.
ESSENTIAL JOB FUNCTIONS:

• Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the departments policies and procedures.
• Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes.
• Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges.
• Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention.
• Coordination of services for members, including community resources and collaboration with other members of the care team.
• Educate members and their caregivers on conditions and self-management techniques.
• Participate in elements of the SNP MOC, including completing HRA and working with the member to reach desired goals, under the direction of the assigned Case Manager
• Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care.

EDUCATION AND EXPERIENCE:

• Active Licensed Practical Nurse in the state of Oklahoma required
• Active multi-state license is preferred
• Previous experience in managed care/utilization management preferred

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources.
• Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals.
• Must be able to communicate, both orally and in writing, clearly and effectively
• Knowledge of Microsoft software programs including Word, Excel, and PowerPoint.
• Proven ability to work independently or as a member of a team.

WORK ENVIRONMENT:
Current work environment is remote, however, some state exclusions apply.
Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.
TRAVEL:
N/A
SUPERVISORY RESPONSIBILITY:
N/A
OTHER DUTIES:
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.