Job: Telephonic RN Case Manager - Complex/Disease

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Jobing Description

The Telephonic RN Case Manager is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. The Case Manager may also be responsible for providing health education, coaching and treatment decision support for members.Responsibilities:
Making outbound calls to assess members' current health status
Identifying gaps or barriers in treatment plans
Providing patient education to assist with self management
Interacting with Medical Directors on challenging cases
Coordinating care for members
Making referrals to outside sources
Coordinating services as needed (home health, DME, etc)
Educating members on disease processes
Encouraging members to make healthy lifestyle changes
Documenting and tracking findings
Utilizing Milliman criteria to determine if patients are in the correct hospital setting
Making 'welcome home' calls to ensure that discharged member receive the necessary services and resourcesWhat makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.Requirements:Requirements:Current, unrestricted RN license in the State of Nevada2+ years experience in a hospital setting, acute care, direct care experience (experience working with diabetes, cancer, stroke, traumatic brain injury, heart disease, lung disease or related experience is preferred)Basic level of experience with Microsoft Word, with the ability to navigate a Windows environmentHigh school diploma or equivalentAbility to work with patients over the phone to guide, educate and assist them with their healthcare needsStrong written and oral communication skillsGood problem solving skillsPreferred Assets:Bachelor's DegreeA background in managed care2+ years of experience in Case Management experience (highly preferred)Experience as a telephonic Case Manager for an insurance companyCertified Case Manager (CCM)Experience/exposure with discharge planningExperience in utilization review, concurrent review and/or risk managementStrong organizational skills and multitasking abilities will be keys to successUnitedHealthcare 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.

Skills / Requirements

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