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As part of a care coordination team, the Medical RN Case Manager will be the primary care manager for a panel of members with complex medical needs. The RN Care Management/coordination activities will focus on supporting member’s medical, behavioral and socioeconomic needs to promote appropriate utilization of services and improved quality of care. All case management/coordination activities will be in alignment with evidence-based guidelines.
If you are located in or near in Oklahoma City, OK, you will have the flexibility to telecommute* as you take on some tough challenges. (Please note that this is a work from home opportunity, but you need to live in or near the posted area)
- Serve as primary care manager for members with complex medical needs
- Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural and socioeconomic needs
- Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
- Partner and collaborate with internal care team, providers, community resources/partners and leverage expertise to implement care plan
- Monitor and update care plan, incorporating feedback from member to monitor compliance with interventions to achieve care plan goals
- Provide education and coaching to support:
- Member self-management of care needs in alignment with evidence-based guidelines
- Lifestyle changes to promote health, i.e. smoking cessation, weight management, exercise
- Perform targeted activities and provide education to support gap in care closures, including scheduling, reminding and verification of appointment to receive specific services Monitor compliance with medication regimen and make referrals to Pharmacist for medication review and recommendations
- Reassess and update care plan with change in condition or care needs
- Support discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
- Access and Coordinate Medicaid Benefits to support care needs
- Document all care management/coordination activity in clinical care management record
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.
- Registered Nurse with current and unrestricted license in the state of residence
- 4+ years of relevant clinical work experience
- Experience with Medicaid or Medicare populations
- 1+ year(s) of community case management experience coordinating care for individuals with complex needs
- Knowledge of Medicare and Medicaid benefits
- Ability to navigate a windows environment and utilize Microsoft Office (Word, Excel, Outlook)
- You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
- Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
- Home Health Experience
- Psychiatric nursing experience
- Experience with arranging community resources
- Prior field-based work experience
- Demonstrated ability to communicate ideas clearly and concisely
- Bilingual in Spanish
Physical Requirements and Work Environment:
- Ability to transition from office to field locations multiple times a day if needed
- Must possess transportation to visit clients in various locations
- Ability to travel varied distances and multiple locations / terrains to visit assigned client locations
- Ability to carry equipment to and from field locations needed for face to face member visits (ex. laptop, etc.)
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.
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