[Hiring] Field RN Service Coordinator 1 - Case Manager @UnitedHealth Group

Role Description

As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy, and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come.

If you are located in El Paso, TX you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Conducting telephonic or face-to-face holistic evaluations of Member's individual dynamic needs and preferences.
• Gathering relevant data and obtaining further information from Member/family.
• Identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports.
• Providing education and support to Member/LAR on options of Consumer Directed, or Service-Related delivery models as applicable.
• Performing initial assessments and follow-up assessments and outreach calls within the time specified as part of contractual guidelines or per Member/family/provider request.
• Identifying members for high-risk complications and coordinating care with the member and the health care team.
• Managing members with chronic illnesses, co-morbidities, and/or disabilities to ensure cost-effective and efficient utilization of health benefits.
• Assessing, planning, and implementing care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care.
• Utilizing both company and community-based resources to establish a safe and effective case management plan for members.
• Collaborating with member, family, and healthcare providers to develop an individualized plan of care.
• Identifying and initiating referrals for social service programs, including financial, psychosocial, community, and state supportive services.
• Managing care plan throughout the continuum of care as a single point of contact.
• Communicating with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members.
• Advocating for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the healthcare team.
• Utilizing approved clinical criteria to assess and determine appropriate level of care for members.
• Documenting all member assessments, care plans, and referrals provided.
• Participating in Interdisciplinary team meetings and Utilization Management rounds and providing information to assist with safe transitions of care.
• Understanding insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan.
• Monitoring services being delivered to ensure timeliness, appropriateness, and satisfaction in meeting Member needs.
• Reporting medically complex cases to appropriate roles as necessary for review and problem solving.
• Maintaining status on face-to-face and telephonic visit requirements for assigned Members.

Qualifications

• Graduate of an accredited school of nursing.
• Current unrestricted RN license in Texas.
• 3+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities as a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background.
• 2+ years of experience working within the community health setting in a health care role.
• 2+ years of experience working in a community health, clinical, hospital, acute care, direct care, or case management setting.
• 2+ years of experience working with MS Word, Excel, and Outlook.
• Demonstrated knowledge of specific case management processes, and person-centered care practice.
• Demonstrated knowledge of all clinical resources available to patients both inpatient and outpatient.
• Proven excellent verbal and written communication skills.
• Proven analytical decision-making and judgment skills.
• Demonstrated ability to function as a clinical care team leader.
• Proven data entry and word processing skills.
• Ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, etc. This would be in the El Paso TX area.
• Bilingual English and Spanish.
• Reliable transportation with valid driver’s license and good driving record.

Preferred Qualifications

• Bachelor’s Degree in nursing.
• CCM/RUG Certified.
• 2+ years of experience working with Medicaid Waiver populations.
• Experience with electronic charting.
• Experience with arranging community resources.
• Field-based work experience.
• Behavioral Health Experience.
• Experience in managing populations with complex medical or behavioral needs.

Benefits

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

Company Description

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable, and more connected for the people we serve.

We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard, and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences, and perspectives.

UnitedHealth Group and its affiliated brands are 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.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.