Field RN Case Manager - Jefferson County, New York - Full-time / Part-time

• Conduct face to face and telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols


• Assess the patient's current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatment pla


• Engage patient, family, caregivers, and healthcare providers to assure that a well-coordinated treatment plan is established


• Prioritize care needs, set goals and develop a treatment plan (or plan of care) that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation


• Track the patient's health status and progress in achieving clinical and personal goals


• Provide education, information, direction, and support related to care goals of patients


• Coordinate acquisition and proper use of medical equipment, initially and on an ongoing basis


• Communicate with patients, families, caregivers, physicians, and other service providers to coordinate the care needs for the patient


• Collaborate with the attending physicians and Medical Director to revise treatment plans as needed


• Document assessments, interventions, and follow-up on disease management activities 


• Regularly assess the effectiveness and quality of services provided to patients by analyzing outcomes (clinical, functional, and financial)


• Educating local hospitals and clinics on UnitedHealthcare and long term care programs

• Registered Nurse (RN) with active and unrestricted license in the state of NY


• 3+ years of clinical experience to include long-term care, home health care or acute care


• Excellent verbal and written communication skills; ability to speak clearly and concisely


• Reliable transportation to travel to member homes or other locations within service delivery area


• Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of Outlook and other software applications


• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action


• Excellent assessment skills and ability to document members needs in order to calculate appropriate hours of personal care services.

• Experience providing care coordination to persons receiving long-term care and/or home and community based service


• Experience in managed care


• Knowledge of Universal Assessment System


• Knowledge of MLTC with experience utilizing clinical assessment tools such as the SAAM and 485


• Knowledge of PCS including state required documentation: M27R, M11S, M11Q.


• Previous work experience in a field based position


• Working knowledge of Medicare/Medicaid regulations


• Bachelor's Degree or higher


• CCM certification 

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