RN Case Manager - Telecommute in IN or OH

Company: UnitedHealth Group
Location: Carmel
Posted on: January 6, 2022

Job Description:

OptumCare -is a rapidly growing national, integrated health care organization that helps physicians and other providers deliver the right care at the right time in the right setting. - We design and manage delivery systems in markets where we can achieve the -Quadruple Aim -- a better patient experience, higher quality care, lower costs, and a better experience for providers. With our expertise and resources, we are on the front lines transforming the health care delivery system to help improve the overall health of patients and communities.This physician led, patient centric, and data driven business creates value by delivering and facilitating care across the full continuum through high performing networks comprised of owned, managed and contracted physicians, advanced practitioners and other providers. Our system impact extends across physicians, specialty care, urgent care, home health, post-acute transitions, complex care in skilled nursing facilities and palliative care.Job SummaryThe Nurse Case Manager I (NCM) is responsible for patient case management for longitudinal engagement, coordination for discharge planning, transition of care needs and outpatient patient management through the care continuum. Nurse Case Manager will identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a patients' action plan and/or discharge plan. The Case Manager may perform telephonic and/or face-to-face assessments. They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers, educators, health care coordinators/managers. The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence. The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions. The Nurse Case Manager will act as an advocate for patients and their families guide them through the health care system for transition planning and longitudinal care. The Nurse Case Manager will work in partnership with the care team and will coordinate, or provide appropriate levels of care under the direct supervision of an RN Manager or MD. -Primary Responsibilities

• Provide patients with transition of care calls to ensure that discharged patients' receive the necessary services and resources according to transition plan
• Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care
• Independently serves as the clinical liaison with hospital, clinical and administrative staff within our documentation system for discharge planning and/or next site of care needs.
• In partnership with care team, make referrals to community sources and programs identified for patients
• Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health status
• Assess and identify the healthcare, educational, and psychosocial needs of the patient and their family at the initial referral to care management
• Provide member education to assist with self-management goals, disease management or acute condition and provide indicated action plan
• Utilizing evidenced-based practice, develop interventions while considering member barriers independently
• Utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
• In consultation with manager of Care Management, conducts initial assessments within designated time frames for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
• Manages assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers
• Collaborates effectively with Interdisciplinary Care Team (IDCT) to establish an individualized transition plan and/or action plan for patients
• Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding high risk cases and participates in departmental huddles
• Ensure adherence to NCQA requirements for Complex Case Management
• Demonstrate understanding of utilization management processes
• Assists with data collection and closing of care gaps and quality metrics as assigned, and assists the healthcare team in meeting all of the quality metrics
• Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
• Manage assigned caseload in an efficient and effective manner utilizing time management skills
• Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 95% or better on a monthly basis
• Identifies opportunities for process improvement in all aspects of patient careRequired Qualifications:
  • Current, unrestricted RN license required, specific to the state of employment
  • 3+ years of clinical experience
  • Reside in Indiana or OhioPreferred Qualifications:
    • Certification in Case Management (CCM)
    • Experience with Complex Case Management and DSNP NCQA requirements
    • Managed care and/or case management experience
    • Bachelor's Degree in Nursing
    • Experience working with geriatric patient populationsProof of immunity to vaccine-preventable diseases is an employment requirement.UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Job Keywords: -RN, registered nurse, certified case manager, case manager, case management, population health, managed care, Kokomo, Indiana

Keywords: UnitedHealth Group, Carmel , RN Case Manager - Telecommute in IN or OH, Executive , Carmel, Indiana