RN Care Manager - Optum Bayway

Company: Optum
Location: Saint Petersburg
Posted on: June 3, 2025

Job Description:

$5,000 Sign-on Bonus for External Candidates -
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.
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This position is responsible for ensuring the continuity 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 care management functions on-site or telephonically as the need arises. -Works in conjunction with the care team and PCP as care team leader. -Ensures evaluation is in alignment with site-based goals.
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Primary Responsibilities:

Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer
Represents the Company in a professional manner, following all Company policies and procedures
Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
Be able to obtain CPR certification within 90 days of employment (Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)
Prioritizes patient care needs upon initial visit and addresses emerging issues
Meets with patients, patients' family and caregivers as needed to discuss care and treatment plan as delineated in Transitions of Care program
Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings
Consults with physician and other team members to ensure that care plan is successfully implemented
Coordinates treatment plans with the care team and triages interventions appropriate to the skill set of the team members
Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes
Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management
Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care
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 PCP when applicable
Maintains effective communication with the physicians, disease management, hospitalists, extended care facilities, patients and families
Provides accurate information to patients and families regarding plan benefits, community resources, referrals and other related issues
Documents pertinent patient information in Electronic Health Record and FOCUS as appropriate
Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports
Adheres to departmental policies and procedures as approved by Best Practice Committee and QMOC (Quality Medical Oversight Committee)
Work collaboratively with the provider and care team to carry out nursing interventions under proper scope of practice
Performs additional duties as assigned
Travel as necessary, or cover centers remotely, based on business need
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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:

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