CRS High Risk Case Manager - Phoenix, AZ - Full-time / Part-time

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)Primary Responsibilities:

Making outbound calls to assess members' current health status
Identifying gaps or barriers in treatment plans
Providing patient education to assist with self-management
Interacting with Medical Directors on challenging cases
Coordinating care for members
Making referrals to outside sources
Coordinating services as needed (home health, DME, etc.)
Educating members on disease processes
Encouraging members to make healthy lifestyle changes
Documenting and tracking findings
Utilizing Milliman criteria to determine if patients are in the correct hospital setting
Making welcome home calls to ensure that discharged member receive the necessary services and resources

Required Qualifications:

Medicaid, managed care health plan operations experience
A working knowledge of a special needs population
Experience with provider services, billing and enrollment, member services, and claim processes and procedures
Clinical pediatric experience
Mental health/behavioral health experience; working with Arizona's Regional Behavioral Health Authorities (RBHA)
Preferred Qualifications:

Current licensure as an RN or Social Worker in the State of Arizona
3+ years of Management experience
Experience with pediatric disabilities and CRS
Master's degree
Certified Case ManagerCareers 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)
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.
 
Job Keywords:  Case Manager, High Risk Case Manager, RN, LCSW, CRS, Managed Care, Medicaid, Phoenix, AZ, Arizona