- Screens and identifies members with high-risk, long term chronic conditions who will benefit from care management services. Monitors utilization as needed. Referrals for cases may originate from various sources
- Performs member evaluations and onsite visits as needed in multiple settings, including but not limited to: telephonic, member's homes, PCP/Specialists clinic, hospital, and skilled nursing facilities and provides feedback on planned interventions and outcomes of the plan of care
- Performs comprehensive assessments, identifies, and assists members with high-risk symptoms/diagnoses and/or members with multiple co-morbidities who will benefit from intervention and engaging in care management services, information is collected from the patient, caregiver(s), health care providers and other relevant parties as needed
- Documents findings and develops individualized care plans in a concise/comprehensive manner compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
- Utilizes advanced clinical skills to make effective decisions to meet the member's health, behavioral health and psychosocial needs, providing coaching, patient education, communication, and all available resources to promote quality and cost-effective outcomes
- Documents patient/family status, diagnosis, medications, treatment plan, goals, interventions, evaluation results, observations and progress in electronic medical record/proprietary database in a timely and accurate manner
- Advocates for members and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
- Integrates a collaborative approach by attending interdisciplinary team meetings with nurses, physicians and patient care coordinators regarding patient care as needed; Collaborates with providers to determine acuity of behavioral health concerns and refer members to appropriate community resources
- Utilizes professional knowledge and critical thinking skills to facilitate MD consultation on complex and/or complicated cases
- Applies Nursing/Counseling/Social Work theory, knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function
- Manages assigned case load in an efficient and effective manner
- Licenses must be active and unrestricted
- 3+ years of RN experience in a hospital setting, acute care, direct care, or as a telephonic Case Manager for an insurance company
- Proficient computer skills and good working knowledge of Microsoft Word
- Proven ability to function independently and responsibly with minimal supervision
- Proven ability to maintain direct and open communication with all levels of the organization
- Proven ability to handle sensitive issues with members and providers in a confidential manner according to HIPAA guidelines
- Proven ability and flexibility to assume responsibilities and tasks in a constantly changing work environment
- Proven excellent customer service skills
- Proven excellent interpersonal and problem-solving skills
- Proven solid team player and team building skills
- Proven demonstrates initiative in achieving individual, team, and organizational goals and objectives
- Proven solid oral and written communication skills - specifically telephone skills
- Willing or ability to travel locally up to 75% of the time
- BSN
- Licensed RN with 3+ years of experience
- Certified Case Manager (CCM)
- 3+ years of experience in a related mental health environment
- Dual diagnosis experience with mental health and substance abuse
- Experience working in an environment that required coordination of benefits and utilization of multiple groups and resources for patients
- Experience working with low-income populations
- Experience working with the aged, blind or disabled
- Clinical training experience
- Managed Care experience
- Case Management experience
- Experience or exposure to discharge planning
- Experience in utilization review, concurrent review or risk management
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Medical Behavioral Integration - Overland Park, KS, United States - Optum
Description
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.
The Medical Behavioral Integration Nurse is a specialized component of the Optum Care Management Team. This position integrates a collaborative process which plans, implements, coordinates, monitors and evaluates options and services to meet the member's medical and behavioral health needs, using education, communication, and all available resources to promote quality, cost-effective outcomes.
Primary Responsibilities:
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:
Preferred Qualifications:
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
