Field Based RN Case Manager - Cumberland, White and Putman Counties - Full-time / Part-time

• Conduct thorough and objective initial and ongoing face-to-face assessments of the member within specific mandated intervals to determine current status and needs, including physical, behavioral, functional, psychosocial and financial and health status expectation


• Conduct telephonic, face-to-face and other additional assessments as needed to address member change in condition


• Conduct telephonic or on-site grand rounds on members experiencing changes in condition


• Identify members with the potential for high-risk complications and coordinate the appropriate supported self- care in conjunction with the member and care coordination team


• Act as an advocate for an individual's care needs by identifying and communicating opportunities for care interventions, including identifying and addressing functional deficits and gaps in care


• Develops member specific Plan of Care that will be utilized to obtain authorizations for  appropriate home and community based services, collaborating with staff to obtain authorization for those services and confirms that services are being provided and the member's needs are being met while transitioning from nursing facility to home


• Management of critical transitions, supporting legacy discharge planning staff with member transition to the home setting


• For members transitioning to a setting other than a community-based residential alternative setting, monitor the initiation and daily provision of services in accordance with the member's plan of care and take the immediate action to resolve gaps in care


• Develop and implement targeted strategies to improve health, functional or quality of life outcomes, such as disease management or pharmacy management


• Serve as a point of contact for coordination of all physical health, behavioral health and other home and community based services


• Proactively educate members about the program


• Monitor hospitalizations and institutional facility admissions and re-admissions to identify issues and implement strategies to improve outcomes


• Coordinate with member's primary care provider, specialists and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care;


• Routinely assess and monitor member's status, needs and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to their plan of care, providers and/or services to promote better outcomes


• Report quantifiable impact, quality of care and/or quality of life improvements as measured against the care coordination goals


• Establish and maintain professional working relations with referral sources, community resources and care providers


• Collaborates with the peers on member admissions, transitioning and/or discharge planning

• Undergraduate degree or equivalent experience


• Current, unrestricted RN license in the State of TN or the ability to obtain prior to employment


• 2+ years of experience in a hospital setting, acute care, direct care experience


• Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment


• Ability to drive up to 2+ hours each way to members' homes for visits

• Experience in managed care


• Experience working in a field based environment such as home health, hospice or community health


• Case management experience


• Certified Case Manager (CCM)


• Experience/exposure with discharge planning


• Experience in utilization review, concurrent review and/or risk management

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 17 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.




UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.