As the Senior Case Manager you will manage case management services and directs care coordination for high risk members and post acute care discharges. May be clinic based or virtual office. Option for clinic, home, and telephonic visits. The Sr. RN Case Manager works in collaboration with members, providers and key stakeholders in coordinating health services and referrals. Collaborates with physicians and assists in the facilitation of healthcare resources to ensure services and care are delivered in a timely manner. Advocates for patients/families and liaisons with key team member to ensure that patientsâ healthcare needs are being addressed.
Responsibilities:
Applies motivational interviewing in identifying impact on member engagement and setting goals.
Medication: Member education, medication reconciliation and benefit management.
Ensures follow up appointments and referrals to programs, both health plan and community are in place.
Facilitate patient / family and provider communications as indicated and advocate for patient / family with healthcare team as needed.
Communicate with stakeholders, appropriate health care related information to ensure timely coordination care and services for members currently receiving inpatient care. Identified point of contact for managing transitions of care.
Utilizes approved clinical criteria to asses and determine appropriate level of care for members currently receiving inpatient care.
Reevaluates transition of care needs at day 30 and coordinates transition to next level of case management or care coordination
services.
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 and help people live healthier lives while doing your life's best work.(sm) High School diploma or equivalent. Registered Nurse with active unrestricted license in the State of Nevada required.Certification in Case Management (completed or obtained within one year of employment in position)Fast paced facility and/or office setting; may entail frequent driving to various locations.
Qualifications:
Requirements:
Nursing degree required
Registered Nurse with active unrestricted license in the State of Nevada required
5+ years clinical experience in a hospital setting with an emphasis on case management or utilization management required
Ability to work in a face paced environment
Ability to travel to various locations when needed
Strong understanding of insurance products, benefits, coverage limitations, laws and regulations as it applies to the health plan.
Thorough knowledge of UM, case management and discharge planning required.
Strong organizational skills.
Strong interpersonal, verbal and written communication skills required.
Critical thinking skills and ability to oversee teams to meet expected goals.
Self motivated for member and program success.
Ability to contribute to the organization's efforts to eliminate racial and ethnic disparities in organizational performance.
Preferred Assets:
CCM
Clinic or hospital case management experience.
UnitedHealthcare Employer & Individual is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. When you work with UnitedHealthcare Employer & Individual, what you do matters. It's that simple...and it's that challenging.In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.Regardless of your role at UnitedHealthcare Employer & Individual, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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