Optum is seeking a Call Center Nurse RN to join our HouseCalls team in Columbia, MD. Optum is a clinician-led care organization, that is creating a seamless health journey for patients across the care continuum.As a member of the broader Home and Community Care team, you’ll provide annual clinical assessments to patients in the comfort of their homes. This important preventive care helps identify and reduce health risks for patients, in addition to coordinating appropriate follow-up care to improve health and well-being.At Optum, the integrated medical teams who practice within Home and Community Care are creating something new in health care. Together, we are bringing high-end medical service, compassionate care and industry leading solutions to our most vulnerable patient populations. Our holistic approach addresses the physical, mental and social needs of our patients wherever they may be - helping patients access and navigate care anytime and anywhere. We’re connecting care to create a seamless health journey for patients across care settings. Join our team, it’s your chance to improve the lives of millions while Caring. Connecting. Growing together.The HouseCalls Clinical Support Team (HCCST) supports Advanced Practice Clinicians in the HouseCalls program by providing telephonic consultation to plan members post HouseCalls visit. This position is completely telephonic in a call center environment.Goals of the program include providing a one-time outreach to members for follow up post HouseCalls visit to provide education and clarification on any concerns raised during their HouseCalls visit. The main objective of this program is to ensure successful transition of care from the HouseCalls Advanced Practice Clinician back to the members Primary Care Provider.This team includes nurse care managers and social workers. The Nurse Care Manager (NCM) will report directly to the Manager/or Director of Clinical Operations of HCCST. The NCM interacts via telephonic consult with members and providers to assist with education and clarification on any concerns raised during the HouseCalls visit and ensure the member has/or assist in obtaining an appointment with the provider to transition care. They work to ensure members receive quality customer service by answering questions, addressing concerns, providing education, providing resource information, and entering referrals.The schedule is Monday through Friday from 9AM to 5:30PM Eastern or 9AM to 5:30PM Central respectively.Primary Responsibilities:
Perform telephonic outreach to members identified by the Advance Practice Clinician for specific referral related issues
Ensure member has scheduled appointment with Primary Care Provider (PCP)/specialty provider; help scheduling appointment, if needed
Refer members to internal departments such as Social Work, or Clinical Help Desk when appropriate
Gather clinical information telephonically from patient/family
Assist patients/members with urgent needs requiring acute intervention that arise during the call
Identify triggers for hospitalization and barriers to meeting healthcare goals as they arise during the call
Complete required documentation in compliance with auditing standards and policies
Provide patient/family education on disease process and trigger management that arise during the call or are directly related to referral reasons
Assist with connections to appropriate community resources if needed
Understand and maintain confidentiality of legal and ethical issues
Maintain compliance with all HIPAA (Health Insurance Portability and Accountability Act) regulations
Enhance the experience of both internal and external customers by providing excellent customer service while maintaining production metrics
Serve as a clinical resource and consultant for other clinicians
Attend and participate in team huddles and staff meetings
Work with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies
Provide cross-coverage support across the team and assist with special projects, as needed
Assume other duties as assigned and directed by the Supervisor or Manager of Clinical Call Center Operations
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:
Current, unrestricted Compact RN (Registered Nurse) license in the state of residence
Willing and able to obtain additional licensure in assigned states within 6 months of hire
3+ years of clinical experience in a hospital, acute care, home health / hospice, direct care, or case management position
Computer/typing proficiency to enter and retrieve data in electronic clinical records
Proficient with Microsoft Word, Outlook, and Excel
Proven solid problem-solving skills
Proven ability to communicate complex or technical information in a manner that others can understand and the ability to understand and interpret complex information from others
Proven ability to perform positively and efficiently in production driven environment
Dedicated, distraction-free space in home and access to company approved high-speed internet (Broadband Cable, DSL, Fiber)
Preferred Qualifications:
Telephonic case management experience
Home care / field based case management
Medicaid, Medicare, or managed care experience
Experience working remotely from home
Experience working in a call center environment
Experience working in a metrics-driven environment
Demonstrated excellent customer service skills
Reside in the Central or Eastern time zone
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.