Field Based RN Case Manager - Merrimack Valley - 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)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)What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.Apply for this position with your eyes wide open. Click here to view the Realistic Job Preview: http: //uhg.hr/Field_Based_Case_Manager_UHCCSThe primary purpose is to deliver the clinical model resulting in effective, consistent, collaborative and coordinated care based on enrollee needs and risk profile. Identifying enrollee needs begins with early identification of health risk factors, ongoing assessment, care planning, intervention, and evaluation, and prevention of primary or secondary risk factors.Primary Responsibilities:

Responsible for new Admissions to UHC SCO for a specified region
Responsible for reaching out to new members PCP and gathering medical info
Complete all necessary clinical assessments and state required assessments
Designing Plan of Care for the new member to maintain health, independence, and safety
Identifies formal and informal resources to meet the enrollee needs as stated in the plan of care.
Enters service notifications according to guidelines
Communicates with the enrollee primary care physician, other physicians and community partners concerning clinical needs and care alternatives.
Serves as enrollee advocate and facilitator to resolve issues that may be barriers to care.
Through developing a relationship with the enrollee /family, the clinical care manager educates the enrollee /family about their health conditions, treatment options, community resources, health insurance benefits and psychosocial concerns so that informed decisions can be made and enrollee self-management is promoted
Ensures appropriate utilization and consistent application of the benefits Maintains time sensitive documentation including case management interventions and outcomes to assure compliance with program goals and regulatory agencies
Organizes work and develops strategies for adapting to a constantly changing workload or when confronted with unseen situations
Facilitates early identification of changes in condition so that effective treatment can be initiated promptly, reducing the need for preventable emergency room visits, nursing home placements and hospitalizations
Provides care management services in the community, including on-site and telephonic reassessments according to protocol.
Monitors enrollee's responses to the interventions and adjusts plan of care as needed.
Monitors hospital and SNF admissions according to post hospital program and provides education and/or interventions as necessary to reduce frequency
Participates in the Quality Improvement process including the recognition of quality of care issues and forwarding information to appropriate staff for review and resolution
Performs other duties as assigned

Requirements:

Current, unrestricted RN license in the State of MA or the ability to obtain prior to employment
Reliable transportation to travel to member homes or other locations within service delivery area
3+ years clinical experience in a hospital, acute care, home health/hospice, 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
Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Preferred Assets:

Case Management experience including Certification in Case Management (CCM)
Home care/field based case management
Medicaid, Medicare and/or Managed Care experience
Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Bilingual skills in Spanish
Experience in Home & Community based or Long Term Care services delivery
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.SMDiversity 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.Keywords: RN, Nurse Case Management, certified case manager, Medicare, Medicaid, LTC, home health care, managed care, MA, Massachusetts, bilingual