Field Case Manager - Philadephia, PA

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)
 
Responsible for managing the medical care received by a claimant following an injury. The Medical Case Manager monitors all treatment and acts as a liaison between the account, provider, and the claimant for returning the claimant to health and/or work in an appropriate amount of time based on disability guidelines and physician assessment) and is responsible to coordinate care with quality and cost effective outcomes.
 
Primary Responsibilities:

Implements and acknowledges all new referral contacts to account, claimant and physician within same business day
Monitors all treatment and acts as a liaison between the account, provider, and the claimant
Arranges and attends all medical evaluations, physician appointments and physical therapy when needed, including those that may occur before and after regular business hours, or on weekends /holidays in the event of catastrophic cases
Cases are assigned with geographic location taken into consideration, but territory may extend beyond a given location and cross state lines in some instances, depending upon need
Participates in coverage as needed for other team members
Coordinates Independent Medical Examinations, as well as provider appointments.
Participates in coordination of services for catastrophic cases to include, but not limited to, immediate visit at Hospital to secure all accident and treatment information, coordination of discharge and home care needs
Arranges transportation services when necessary and authorized
Reviews and evaluates all medical correspondence obtained from providers
Coordinates and monitors home health care as necessary
Implements and utilizes community resources when applicable
Coordinates case management reviews with the Case
Management Supervisor on all files
Provides medical testimony as required  

Required Qualifications:

This position requires that the requirement for case manager are met, which include:

(a) A current, unrestricted RN license or certification to practice a health or human services discipline in a state or territory of the United States that allows the health professional to independently conduct an assessment as permitted within the scope of practice of the discipline; or
(b) In the case of an individual in a state that does not require licensure or certification, the individual must have a baccalaureate or graduate degree in social work, or another health or human services field that promotes the physical, psychosocial, and/or vocational well being of the persons being served, that requires: 

 (i) A degree from an institution that is fully accredited by a nationally recognized educational accreditation organization; (No Weight)
 (ii) The individual must have completed a supervised field experience, in case management, health, or behavioral health as part of the degree requirements; and
(iii) URAC-recognized certification in case management within four (4) years of hire as a case manager
Two years full-time equivalent providing direct clinical care to the consumer
Must be able to travel and have a valid driver’s license, reliable transportation and current motor vehicle insurance coverage
Excellent communication, interpersonal and organizational skills.
Understanding of managed care, insurance terminology, disability, and workers compensation laws
Proficient computer skills including typing and Microsoft Office software
Careers with OptumRx. We’re one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You’ll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There’s no better place to help people live healthier lives while doing 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: RN, registered nurse, case management, URAC, Philadelphia, PA, Pennsylvania