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RN Complex CM - Telecommute in PST

Company: UnitedHealth Group
Location: San Antonio
Posted on: November 26, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

The Case Manager is responsible for managing acute and skilled inpatient and outpatient populations of patients with complex and serious problems requiring special healthcare needs such as but not limited to frail elderly, high-risk OB, transplants, complex HIV positive AIDS with multi-system involvement, pediatrics, and chronic conditions such as CHF, COPD, diabetes and cardiac disease including coordination with California Children's Services (CCS) for CCS qualified conditions for Medi Cal and Healthy Families members. Individual services are coordinated for patients whose needs include ongoing medical care, home health and hospice care, rehabilitation services and preventive services

If you are located within PST, you will have the flexibility to telecommute as you take on some tough challenges.

Primary Responsibilities:

  • Identifies, coordinates, and evaluates appropriate high-quality services, which may be delivered on an ongoing basis
  • Manages a case load of 100 to 150 complex cases
  • Oversees the population management cases that are managed by the case management assistant
  • Works collaboratively with the patient, physician, family/significant other and providers of healthcare to implement plan of care to meet the individual needs
  • Works collaboratively with discharge planners at the affiliated hospitals and case management staff at the contracted health plan offices as required
  • Identifies acceptable care options to the patient and family, utilizing the Case Management Society of America (CMSA) standards
  • Coordinates resources to reduce fragmentation of services and facilitate the achievement of realistic treatment goals
  • Promote optimal allocation of health dollars through arrangement of broad-spectrum (comprehensive) effective and efficient resources for patients
  • Provides patients with education and training regarding specific health care needs
  • Monitors care, which is easily accessible with no access barriers as related to the patient's available benefits
  • Monitors medications for compliance and potential polypharmacy issues
  • Facilitates early and intensive treatment intervention in the least restrictive setting
  • Facilitates the scheduling of follow up services as appropriate
  • Provides counseling to members who are non-compliant with their plan of treatment
  • Applies approved decision criteria to the management of complex and chronic cases and provide immediate risk identification of potential complications information to health care practitioners
  • Complies with approved time frames and standards for timeliness of Medical Management decision-making
  • Provides accurate and up-to-date information to practitioners regarding clinical practice guideline criteria and patient information
  • Creates individualized treatment plans that are:
    • Facilitates the instruction in the use of medical equipment
    • Utilizes multidisciplinary clinical, rehabilitative and support services
    • Grants adequate attention to patient satisfaction through the evaluation and improvement of the case management process
    • Upholds strict rules of confidentiality
    • Provides ongoing Case Management program analysis and development
    • Encourages collaborative collegial approaches to the Case Management process
    • Promote the Case Management Program's viability and accountability
    • Provides population management to patients with chronic conditions such as chronic kidney disease / renal failure, diabetes, CHF, COPD, Asthma, vascular and or wounds
    • Other duties as assigned 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:
      • Active unrestricted RN license in the State of California
      • Valid California Drivers license and insurance
      • 2+ years of experience in managed care environment, preferably in an IPA or MSO. Other case management experience will be considered
      • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Preferred Qualification:
        • CCM Specific Knowledge, Skills, and Abilities:
          • Knowledge of HMO UM and QM Processes
          • Knowledge of and experience with the utilization of UM criteria such as Milliman & Robertson, Medicare and Medicaid guidelines, health plan criteria, etc.
          • Knowledge of and experience with medical coding
          • General knowledge of IPA Operations
          • Familiar with various financial risk arrangements
          • Computer literate in Microsoft Word and Excel
          • Solid verbal and written communication skills
          • Solid ability to work effectively with physicians and other clinical and operational staff, both written and verbally
          • Self motivated with strong organizational skills
          • Flexible and adaptable of schedule to attend various meetings and/or promotional events
          • Ability to look at challenges as opportunities
          • Ability to read quickly with excellent comprehension and retention Physical Demands

            The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. In table below show the minimal physical and weight requirements for this position by checking the appropriate boxes.

            To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

            Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

            Nevada Residents Only: The hourly range for Nevada residents is $28.85 to $51.30. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

            All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

            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.

Keywords: UnitedHealth Group, San Antonio , RN Complex CM - Telecommute in PST, Healthcare , San Antonio, Texas

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