884600 RN Case Manager La Crosse WI

Improve the lives of others while doing your life's best work.SM

RN Case Manager - La Crosse, WI (884600)

Position Description

At Optum, the mission is clear:  Help people live heathier lives and help make the health system work better for everyone

 

LHI is one of 4 businesses under OptumServeOptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans.  By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.

 

LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

 

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work. (sm)

 

As a RN Case Manager, you can assess and coordinate care for a very diverse population of members of the World Trade Center (WTC) Health Program throughout the United States. This is a multifaceted role that is highly rewarding as your work is helping people live healthier lives.

 

Primary Responsibilities:

 

  • Educate and inform members of program coverage and limitations while ensuring that high quality and cost-effective care is provided within contract requirements
  • Use critical thinking and problem solving skills to navigate through the complexities of a member’s health conditions while maintaining coverage within the program guidelines
  • Coordinate health care services for members
  • Prepare and summarize medical history information on members to present to the Medical Director
  • Cultivate relationships with members, providers, co-workers, and other team members to ensure program compliance and member satisfaction
  • Manage an assigned caseload which entails assessment, education and coordination of care for members/health care providers throughout the United States telephonically while keeping a detailed medical record within internal database. Establish and maintain regular contact with members, providers and department supervision
  • Manage inbound and outbound calls from providers to prior authorize tests and procedures related to members’ certified health conditions and program coverage
  • Review medical records (monitoring, treatment and supportive) to determine WTC relatedness for potential program coverage and communicate results to members
  • Completion of system generated tasks, including documenting all results as required in internal database (MedNet)
  • Prepare comprehensive reviews and summaries for medical appeals, determination of coverages, and requests for treatment services
  • Point of contact for internal departments to answer questions relative to members of their assigned caseload
  • Completion of medical health questionnaires in times of reduced coverage

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in

Required Qualifications:

  • Current, unrestricted RN license in the state of Wisconsin
  • 3+ years of clinical experience as a Registered Nurse
  • Effective interpersonal, communication, and problem solving skills
  • Experience with Microsoft Office programs
  • Ability to work independently as well as on a team
  • Must possess and demonstrate excellent organizational and multi-tasking abilities
  • Strong telephone communication skills
  • Must be able to implement critical thinking and decision making skills in order to identify appropriate care/treatment plans for a wide range of members from low to high complexity
  • Must have the ability to take initiative and be detail-orientated
  • Equivalent combination of education, experience and/or applicable military experience will be considered.
  • Must be available to work out of the La Crosse office on a daily basis 

Preferred Qualifications: 

  • Case Management experience
  • Behavioral health, occupational health or medical/surgical background
  • Previous military healthcare experience
  • Medical call center experience or medical related experience in a corporate/business setting
  • Knowledge of ICD and CPT coding
  • URAC/ISO experience/knowledge
  • National Career Readiness Certificate

 

 

Be part of a health care team where technology, people and action combine to make great things happen every day. Join us and start doing your life's best work.(sm)
Careers with LHI. Our focus is simple. We're innovators in cost-effective health care management. And when you join our team, you'll be a partner in impacting the lives of our customers, and employees. We've joined OptumHealth, part of the UnitedHealth Group family of companies, and our mission is to help the health system work better for everyone. We're located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We're supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission-driven focus. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

 

 

© 2018 OptumCare. All Rights Reserved.

 

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

 

 

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

 

Keywords:  RN, case manager, prior authorization, concurrent review, medical records, coding

  • Requisition Number884600
  • Job TitleRN Case Manager - La Crosse, WI
  • Job FamilyNursing
  • Business SegmentOptumCare

Job Location Information

  • La Crosse, WI
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 25 % of the Time
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt