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- Honolulu, HI
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DSNP RN Case Manager - Telecommute - Hawaii
UnitedHealth Group • Honolulu, HI
Posted 8 days ago
What makes your clinical career greater with UnitedHealth Group? 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.
- Coordinate care needs for the Dual Special Needs Population (DSNP) member, to ensure compliance with the Special Needs Model of Care (SNP MOC) requirements
- Collaborate with other care team staff (SCs, CCMAs, CHWs) to identify gaps in care or barriers in treatment plans and make recommendations as needed
- Evaluate members’ records to ensure compliance with completion of assessments and services plans within the required timeframes complete member assessments and service plans when indicated
- Outreach to members referred by the CHW for disease management or with other clinical needs, including post-hospital discharge needs such as medication reconciliation
- Provide patient education to assist with member self-management plans
- Make referrals to outside sources when indicated
- Educate members on disease processes
- Encourage members to make healthy lifestyle changes
- Document and track findings
- Prepare for and participate in all required DSNP member audits, including monthly audits conducted telephonically by regulatory compliance
- Other duties as assigned
- Current, unrestricted RN license in the State of Hawaii
- 2+ years of experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
- Ability to navigate a Windows environment, utilize Outlook and the ability to create, edit, save and send documents utilizing Microsoft Word
- Experience working collaboratively in a telephonic environment
- Experience communicating and presenting via WebEx
- Current access or ability to obtain internet access via a landline
- The ability to travel in assigned region to visit UHC members in their homes and/or other settings, including community centers, hospitals or providers' offices
- Bachelor's Degree
- A background in managed care
- Case Management experience
- Utilization management experience
- Experience with Medicare / CMS guidelines
- Certified Case Manager (CCM)
- Experience / exposure with discharge planning
- Experience in utilization review, concurrent review and/or risk management
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)
*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.
Job Keywords: DSNP, RN, Registered Nurse, Case Manager, Care Coordinator, Clinical Coordinator, Telephonic, CCM, Utilization Management, Honolulu, Hawaii, HI, Telecommute, Telecommute, Telecommuting, Remote