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Hours Full-time, Part-time
Location Eugene, OR
Eugene, Oregon

About this job

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. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)


 


This is a field based position traveling to provider offices in the Eugene, OR area.  You will be responsible to review charts (paper and electronic - EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention.  You will be working at the provider office on a daily basis.  This position is Monday - Friday during business hours.


 


Apply for this position with your eyes wide open. Click here to view the Realistic Job Preview:


 


Primary Responsibilities:



  • Primarily provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation

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

  • Determines member's overall bio-psychosocial needs and develops individualized member service/care plan based on assessment data, member and caregiver/ stakeholder input, and cost-effective options for service delivery

  • Provides options and choices for long –term care community or facility-based service delivery

  • Develops member goals in coordination with member and provider

  • Routinely and as needed evaluates the effectiveness of the care/service plan and makes appropriate revisions per policy & procedure/ state contractual requirements

  • Facilitates care setting transitions and access to special programs (e.g. Hospital to Home, Advanced Illness, transition from Nursing Facility to community setting)

  • Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness

  • Coordinates benefits through other available payment sources

  • Assists the member to access community, Medicare, family and other third-party resources as appropriate

  • Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member

  • Provides education to members regarding health care needs, available benefits and services

  • Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care

  • Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address

  • Documents all care coordination activities and interventions in the member's health plan clinical record

  • Maintains a focus on timely, high-quality customer service

  • Maintains the confidentiality of all sensitive information

  • Primarily provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation

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

  • Determines member's overall bio-psychosocial needs and develops individualized member service/care plan based on assessment data, member and caregiver/ stakeholder input, and cost-effective options for service delivery

  • Provides options and choices for long –term care community or facility-based service delivery

  • Develops member goals in coordination with member and provider

  • Routinely and as needed evaluates the effectiveness of the care/service plan and makes appropriate revisions per policy & procedure/ state contractual requirements

  • Facilitates care setting transitions and access to special programs (e.g. Hospital to Home, Advanced Illness, transition from Nursing Facility to community setting)

  • Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness

  • Coordinates benefits through other available payment sources

  • Assists the member to access community, Medicare, family and other third-party resources as appropriate

  • Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member

  • Provides education to members regarding health care needs, available benefits and services

  • Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care

  • Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address

  • Documents all care coordination activities and interventions in the member's health plan clinical record

  • Maintains a focus on timely, high-quality customer service

  • Maintains the confidentiality of all sensitive information

 

Requirements

Required Qualifications:


  • Current, unrestricted RN license in the State

  • Reliable transportation, valid and unrestricted driver's license, proof of insurance and ability to travel to provider offices, member homes or other locations within service delivery area

  • Minimum of 3 years clinical experience in a hospital, acute care, home health, direct care or case management

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

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

  • Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

  • Must be able to travel to provider offices within service area – may require up to 1 hour radius for travel

Preferred Qualifications:


  • Bachelors of Science in Nursing

  • Case Management experience including Certification in Case Management

  • Experience in intensive care (ICU) or emergency department (ER) nursing

  • Prior Physician Office experience

  • Home care/field based case management

  • Medicaid, Medicare, Managed Care experience

  • Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs

  • Call Center experience

  • Experience in working with patients in Home and/or Community based setting

  • Experience with HEDIS and EMR (electronic medical records)

  • Experience with navigating and analyzing reports in Microsoft Excel

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to 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, 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.

 

Key Words:  case manager, nurse, RN, registered nurse, MCO, managed care, chart review, wellness, provider, Eugene, OR, Oregon, CCM, managed care, Medicare