Job Information
UnitedHealth Group Clinical Nurse Liaison in Worcester, Massachusetts
Reliant Medical Group, part of the Optum family of businesses, is seeking a Clinical Nurse Liaison to join our team in Worcester, MA. 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. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. 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.
Schedule : Full-time; Monday - Friday. No weekends, evenings or Holidays
If you are located in the Worcester, MA area, you will have the flexibility to work from home and in the office in this hybrid role* as you take on some tough challenges.
Primary Responsibilities:
Conducts concurrent or retrospective utilization review applying approved utilization criteria for all inpatient admissions and/or observation services. Obtains appropriate authorizations from managed care organizations. Obtains clinical, functional and psychosocial information from the medical record and from the patient directly in a collaborative effort with other health care professionals, patient and/or family.
Identifies, implements and continually reassesses the discharge plan. Collaborates with health care professionals to facilitate a safe, timely discharge from the inpatient setting which provides a positive outcome for patient. Uses evidence based assessment of most appropriate setting for discharge; engages skilled facility staff in clinical dialogue prior to discharge to a skilled nursing facility; assesses home care needs and arranges for appropriate services to meet those needs.
Supports readmission reduction activities by ensuring an effective transition of care on discharge from the acute care facility. Identifies high risk patients; coordinates both the home visit program for Transitions in Care support; and the medication reconciliation for all patients not enrolled in the Transitions in Care program. Ensures that all clinically appropriate follow up appointments, tests, and home visits are scheduled prior to discharge with, at a minimum, a follow up appointment with the PCP within 5-7 days of discharge.
Acts as a liaison between patients/families, Hospital; the organization; and the patient’s Health Plan. Clarifies policies and procedures and patient benefits as needed. Authorizes services, coordinates care, and ensures timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate.
Reviews cases with attending physician to ensure adherence to appropriate care paths and clinical guidelines; identifies opportunities to reduce gaps in care and improve adherence to appropriate guidelines; identifies facility opportunities for improved efficiencies; and refers cases to the Medical Director to assist in addressing resolution of these gaps in care or systemic issues.
Documents all interventions and communications appropriately in the medical record and keeps records and submits reports as assigned by Manager.
Identifies patients who would benefit from disease management, case management, or intensive case management services such as Home Run. Refers and enrolls these identified patients to the appropriate Care Management programs and/or other community services according to protocol. Engages patients prior to discharge in the identified program by sharing appropriate materials and setting expectations.
Supports the wishes of those patients at the end of life including supporting adherence to MOLST orders; identifies patients who are candidates for MOLST orders and supporting the attending physician in educating the patient and their PCP in regards to that option; identifies and educates appropriate patients in regards to their hospice and palliative care benefits and supports their attending and/or PCP in enrollment into those programs for those patients who choose that benefit.
Promotes the communication process between all team members, including the patient, family and all parties involved, to enhance collaboration and achieve optimal outcomes for the patient and the Plan.
Reliant Medical Group joined Optum in 2018, to be part of the greater vision to make health care better for everyone. At Reliant, you're part of a community-based, multi-specialty, clinician-led medical group in Central and Boston Metro-west Massachusetts. Where everyone works collaboratively on a common purpose: improving the quality, cost and experience of health care. Supported by a patient-centric business model – integrated care teams focus on the best patient care, rather than volume. Recognized nationally for an innovative, sustainable care model we offer a full range of outpatient primary care and over 30 different specialties including hospital medicine, comprehensive radiology services, and urgent care. Together, we're making health care work better for everyone.
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:
Graduate from an accredited school of nursing
Active, unrestricted licensure as a Registered Nurse in Massachusetts
5+ years of nursing experience, preferably with older patients
Preferred Qualifications:
Certification in Geriatric Nursing or Geriatric Case Management
Experience with Utilization Review & MDS
Proficient in computer use, the Internet and health information technology
Proven ability to work effectively both independently as well as a member of an interdisciplinary team
Demonstrated excellent communication, interpersonal and organizational skills, with a flexible and creative approach to problem solving
The salary range for this role is $59,500 to $116,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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.