In your field, learning never stops. And neither do you. You are continually pushing yourself to reach higher and go further. To do everything you can to ensure a positive outcome for our patients. Staying on top of your game and persevering in the face of challenge will be a big part of your success. And at every turn, you'll have the support of an elite and dynamic team. Join us in this role and you will use your diverse knowledge and experience to make health care work better for our patients, while doing your life's best work.(sm)
In this role as a RN Case Manager you will work in the field and coordinate care on behalf of Medicaid patients who are receiving long-term care (LTC), along with home and community services (HCBS). Your experience with hospital and long-term care facilities will be essential in relaying the pertinent information about the patient needs and advocating for the best possible care available. At times, your patience may be challenged. But in the end, your confidence, decisiveness and perseverance will help you positively impact our patient lives, and ensure more positive outcomes for all.
What makes your clinical career greater with UHC? You'll work within 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. JOIN US! APPLY NOW!
This is a field-based role with a home-based (telecommute, work at home) office. You will be spending approximately 75% of the time in the field within an assigned coverage area. Candidates must be willing to travel within the McMinn County.
- Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care
- Utilize both company and community - based resources to establish a safe and effective case management plan for members
- Collaborate with patient, family and healthcare providers to develop an individualized plan of care
- Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
- Manage care plan throughout the continuum of care as a single point of contact
- Communicate with all stakeholders the required health - related information to ensure quality coordinated care and services are provided expeditiously to all members
- Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team
- Utilize approved clinical criteria to assess and determine appropriate level of care for members
- Document all member assessments, care plan and referrals provided
- Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care
- Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
- Accountable to understand role and how it affects utilization management benchmarks and quality outcomes
- Licensed RN for the State of Tennessee
- 1 years of clinical or case management experience
- 1 year of experience in hospital, long - term care, home health, hospice, public health or assisted living
- Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
- Medicare, Medicaid or Medicaid Waiver experience
- A background working in geriatric special needs
- Experience with community based resources
- Managed Care experience
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
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, Nurse, Registered Nurse, Social Worker, Clinical, LBSW, LMSW, LCSW, mental health, behavioral health, case management, case manager, home and community based services, long-term care, LTC, hospice, public health, assisted living, Medicare, Medicaid, Waiver, healthcare, managed care, field-based, Athens, McMinn County, TN, Tennessee, UHG, UnitedHealth Group, UHC, Unitedhealthcare, Community and State