AppleCare Medical Group, part of OptumCare®, is a group of leading, independent physicians that provide excellent care and quality service. Our doctors work with a team of AppleCare nurses, social workers and pharmacists to provide expert, personalized care. AppleCare Medical Group is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.
The Manager of Case Management - La Palma, CA will be responsible for the oversight and facilitation of the Case Management and Quality Management processes and assisting the Director and Vice President of Clinical Services with CM functions as necessary and Clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating), Case management and coordination of care. The manager will set team direction, resolves problems and provides guidance to members of the team to ensure the team meets established performance metrics and performance guarantees.
*This is an office-based management position, located in La Palma, CA and requires local travel of up to 20%, traveling to hospital and skilled facilities*
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.
Case Management including, but not limited to, the management and coordination of care for high risk, transplant, CCS and CPSP populations
Referral Management (authorizations, denials, modifications)
ESRD & Institutional tracking
Provider education & corrective action letters
Participation in PCP & Provider Office Meetings
Identify and prioritize gaps to develop plan of care to empower consumers to meet identified goals for staff
Participation in the IPA Quality Improvement Committee & Peer Review and Credentialing Committee
Other duties as assigned.
- Associates Degree
- Current and unrestricted RN license for the state of California
- 3+ years experience as a manager working in hospital, acute, direct care, skilled settings OR experience as a telephonic Case Manager for an insurance company
- Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment
- Bilingual Spanish speaking (ability to read, write, speak)
- Bachelor’s degree in nursing (BSN)
- Case Management Certification (CCM)
- Knowledge of and experience with the utilization of UM criteria such as Milliman & Robertson, Medicare and Medicaid guidelines, health plan criteria, etc.
- Experience as a case manager, experience with utilization management
- Experience working with Medicare members
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: RN Case Manager, Case Manager, Nurse Care Manager, RN, Case Management, Certification in Case Management (CCM), BSN, utilization management, quality improvement, discharge planning, skilled, SNF, milliman, AppleCare, CA, California, Long Beach, Lynwood, Anaheim, Los Angeles, La Palma
Please see job description.