Job Description

Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

Responsible for ensuring the transition 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 continuity of care clinic support functions on-site or telephonically per member care delivery needs. Works in conjunction with the PCP and care team in an active leadership role. Ensures evaluation is in alignment with site-based goals. 

This is a hybrid role that requires some field work/travel up to 3 days per week.

Primary Responsibilities:

• Prioritizes patient care needs upon initial patient/family encounter and addresses emerging issues
• Meets with patients, patients’ family, and caregivers to discuss care and treatment per member care delivery needs 
• Identifies and assists with the patient follow-up in acute care settings, skilled nursing facilities, custodial and ambulatory settings 
• Uses established protocols, pathways, clinical support resources, to optimize clinical outcomes
• Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
• Maintains effective communication with the physicians, hospitalists, care teams, extended care facilities, patients, and families
• Demonstrates a thorough understanding of the cost consequences resulting from care delivery decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and associated care delivery reports 
• Consults with physician and other team members to ensure that plan of care is successfully implemented 
• Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management
• Works in coordination with the care team and demonstrates accountability with patient management and outcome 
• Discusses Durable Power of Attorney (DPoA) and advanced directive status with care team when applicable 
• Provides accurate information to patients and families regarding plan benefits, community resources, referrals, and other related issues
• Documents pertinent patient information in applicable electronic platform(s)
• Ability to work collaboratively with the provider and care team to carry out nursing interventions under proper scope of practice 
• Ability to provide remote clinic coverage if needed
• Ability to travel to meet patients and families per care delivery needs
• Performs additional duties as assigned 

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: 

• Associate degree in nursing or LPN with four or more years of experience
• Nurse with an active and unrestricted license to practice in the state of Florida
• 2+ years applicable clinical experience in a physician’s office, clinical or hospital setting
• Valid Florida driver’s license and proof of insurance. Ability to use own vehicle to meet patients and families per care delivery needs  

Preferred Qualifications: 

• CCM Certification
• Comprehensive care continuum management, utilization review or discharge planning experience 
• HMO experience 

Knowledge, Skills, and Abilities: 

• Computer literate 
• Knowledge of HIPAA regulations
• Knowledge of current standards of patient care 
• Thorough understanding of professional scope of practice. Knowledge and skill in the applications of the techniques and practices of the nursing profession 
• Embraces and exemplifies core values of Optum and WellMed 
• Understands value-based care principles and has proven ability to integrate those principles into own clinical practice 
• Able to understand, manipulate, and interpret complex data from a variety of reports 
• Able to evaluate new technology and make recommendations for implementation 
• Value team members and a strong team player 
• Possesses high ethical standards
• Able to make effective and timely decisions 
• Demonstrated leadership skills and proactively looked for solutions, which produce measurable outcomes
• Ability to explain medical instructions to patients and their families 
• Ability to make sound, independent judgments, and act professionally under pressure 
• Ability to learn and understand appropriate Federal, State, and local regulations 
• Ability to communicate effectively with patients and all levels of personnel/customers in a professional, courteous, and effective manner using excellent customer service skills
• Ability to be a clinical resource for non-licensed office staff 
• Ability to prioritize and multi- task in a high paced environment with good organizational skills 
• Display initiative, accountability, and resourcefulness 
• Ability to perform care management per industry best practice

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 hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

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.

UnitedHealth Group 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.

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

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