[Hiring] Case Manager - Registered Nurse @UnitedHealth Group

Role Description

The Care Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs. The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of care management and discharge planning. It is the purpose of the Care Manager – Registered Nurse to ensure that the psychosocial and educational needs of the members are met. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Care management services may be provided telephonically, in a provider office, or at the members’ home.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Develop a comprehensive care management plan that will address members’ individual needs which include specific objectives, goals, and actions.
• Prioritizes member care needs upon initial interaction/assessment and address emerging issues.
• Assist members in the management of illness and treatment, monitor adherence, and proactively investigate and address problems that may contribute to non-adherence with the members and other members of the multidisciplinary team.
• Assesses reports, data, and other health plan information to identify potential members in need of care management intervention.
• Decrease healthcare costs of members by working collaboratively to assist members in managing visits to primary care, to decrease ER Utilization, number of inpatient hospitalizations, readmits to hospital, admissions to skilled nursing facilities and home health.
• Monitor the effectiveness of the care management plan and short/long term goals and adjust per member need.
• Assesses and prioritizes care referrals to assure program requirements for outreach and engagement are within expected time frames.
• Provides member and family education, support, and encouragement, especially to enhance adherence to treatment regimen and follow up care.
• Develops communication protocols with physicians in the network, clinic, and community so that early notification and intervention by the care management team occurs for members.
• Independently keeps current on areas of care management, quality management, utilization management, member education and preventive health guidelines.
• Provides recommendations in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelines.
• Acts as liaison and members advocate with other care providers and programs.
• Participate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference).
• Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomes.
• Develop an effective support system within the family and community to manage emergency situations and to provide support and safety for the members.
• Acts to prevent suicide and homicide in accordance with state licensure requirements.
• Supports collection of information and other statistical data relevant to care loads, productivity and health care trends within member population.
• Potential for RN oversight of LNP/LVN. Provide clinical supervision and direction to LPN/LVN staff in accordance with state scope of practice and organizational policies.
• Maintain overall accountability for member care outcomes delivered by LPN/LVN.
• Review and validate care plans developed or supported by LPN/LVN staff.
• Provide real-time guidance, coaching and clinical support to LPN/LVN staff.
• Performs additional duties as assigned.

Qualifications

• Degree in Nursing from an accredited school of nursing.
• Unrestricted RN licensure.
• CA license.
• CCM Certification within three years of employment.

Requirements

• Working knowledge of health care delivery systems.
• Working knowledge of PC applications including MS Office Suite and other supportive technology.
• Ability to use written and oral communication skills.
• Ability to read and interpret data.
• Skill in writing clear, grammatically correct, easy to use instructional documentation.
• Ability to identify learning needs, set goals and seek educational opportunities.
• Ability to analyze problems and formulate appropriate plans, solutions, and courses of action.
• Knowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally.
• Ability to work with frequent interruptions.
• Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates.
• Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners.
• Ability to manage detail and work with accuracy.
• Ability to recognize and act appropriately in situations where patient care needs exceed scope of practice.
• Skill in working with a team and the ability to collaborate on projects with colleagues.
• Skill in working effectively under deadlines and changing priorities.
• Ability to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practice.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.