Case Manager Nurse RN - Telecommute from Richmond, VA area

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 work from home / telecommute position from the greater Richmond, VA area. Case managers 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. Case managers primarily work at physician practices on a daily basis. This is a Monday - Friday, normal business hour position.

Primary Responsibilities:

• 
  

  Provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation. No direct patient care



• 
  

  May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols



• 
  

  May interact with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed



• 
  

  Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice.



• 
  

  Partner with the practice's administrative and clinical staff while managing patient appointments and data between visits



• 
  

  Create and maintain a professional and supportive relationship with the patient, provider and office staff  



• 
  

  Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services



• 
  

  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 and available  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

Required Qualifications:

• Current, unrestricted RN license in the state of Virginia


• 
  

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



• 
  

  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 including MS Office and Excel



• 
  

  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 as needed - may require up to 1 hour radius for travel



• 
  

  Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities



• 
  

  Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect



• 
  

  Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s)



• 
  

  Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer

Preferred Qualifications:

• Bachelors of Science in Nursing


• 
  

  Case Management experience



• 
  

  Certification in Case Management (CCM)



• 
  

  Experience with HEDIS



• 
  

  Experience with EMR (electronic medical records)



• 
  

  Experience with navigating and analyzing reports in Microsoft Excel



• 
  

  Medicaid, Medicare, Managed Care experience



• 
  

  Prior Physician Office experience



• 
  

  Home care/field based case management



• 
  

  Experience in intensive care (ICU),emergency department (ER) nursing, or Home Health



• 
  

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



• 
  

  Call Center experience

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: Richmond, VA, Virginia, Stars, HEDIS, quality of care, case manager, care coordinator, RN, registered nurse, work from home, telecommute, CCM, certified case manager