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UnitedHealth Group is a healthcare and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of
Care Manager
Location
United States
Posted
3 days ago
Salary
$60.2K - $107.4K / year
Seniority
Lead
No structured requirement data.
Job Description
Care Manager
UnitedHealth Group
Role Description The Care Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs. The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of care management and discharge planning. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Care management services may be provided telephonically, in a provider office, or at the members’ home. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Develop a comprehensive care management plan that will address members’ individual needs which include specific objectives, goals, and actions. - Prioritize member care needs upon initial interaction/assessment and address emerging issues. - Assist members in the management of illness and treatment, monitor adherence, and proactively investigate and address problems that may contribute to non-adherence with the members and other members of the multidisciplinary team. - Assess reports, data, and other health plan information to identify potential members in need of care management intervention. - Decrease healthcare costs of members by working collaboratively to assist members in managing visits to primary care, to decrease ER Utilization, number of inpatient hospitalizations, readmits to hospital, admissions to skilled nursing facilities and home health. - Monitor the effectiveness of the care management plan and short/long term goals and adjust per member need. - Assess and prioritize care referrals to assure program requirements for outreach and engagement are within expected time frames. - Provide member and family education, support, and encouragement, especially to enhance adherence to treatment regimen and follow up care. - Develop communication protocols with physicians in the network, clinic, and community so that early notification and intervention by the care management team occurs for members. - Independently keep current on areas of care management, quality management, utilization management, member education and preventive health guidelines. - Provide recommendations in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelines. - Act as liaison and members advocate with other care providers and programs. - Participate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference). - Integrate, coordinate and advocate for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomes. - Develop an effective support system within the family and community to manage emergency situations and to provide support and safety for the members. - Act to prevent suicide and homicide in accordance with state licensure requirements. - Support collection of information and other statistical data relevant to care loads, productivity and health care trends within member population. - Potential for RN oversight of LNP/LVN. Provide clinical supervision and direction to LPN/LVN staff in accordance with state scope of practice and organizational policies. - Maintain overall accountability for member care outcomes delivered by LPN/LVN. - Review and validate care plans developed or supported by LPN/LVN staff. - Provide real-time guidance, coaching and clinical support to LPN/LVN staff. - Perform additional duties as assigned. Qualifications - Degree in Nursing from an accredited school of nursing (Bachelor’s degree preferred). - Unrestricted RN licensure. - Compact License. - CCM Certification within three years of employment. - 2+ years of Complex Case Management experience. Requirements - 2+ years of clinical experience in a health care setting, care management for a health insurer. Benefits - Comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). Application Deadline This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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