RN or SW Case Manager - Santa Fe County, NM - Full-time / Part-time

In your field, learning never stops. And neither do you. You are continually pushing yourself to reach higher and go further. To do everything you can to ensure a positive outcome for our patients. Staying on top of your game and persevering in the face of challenge will be a big part of your success. And at every turn, you'll have the support of an elite and dynamic team. Join us in this role and you will use your diverse knowledge and experience to make health care work better for our patients, while doing your life's best work.(sm)In this role, you will work in the field and coordinate care on behalf of patients who are receiving long-term care, along with home and community services. Your experience with hospital and long-term care facilities will be essential in relaying the pertinent information about the patient needs and advocating for the best possible care available. At times, your patience may be challenged. But in the end, your confidence, decisiveness and perseverance will help you positively impact our patient lives, and ensure more positive outcomes for all.
 
To get better insight to this role and determine if it is the right fit for you, click here to view the Realistic Job Preview: http://uhg.hr/SocialWorkerRJP
 
Primary Responsibilities:


Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care

Utilize both company and community-based resources to establish a safe and effective case management plan for members

Collaborate with patient, family and healthcare providers to develop an individualized plan of care

Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services

Manage care plan throughout the continuum of care as a single point of contact

Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members

Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team

Utilize approved clinical criteria to assess and determine appropriate level of care for members

Document all member assessments, care plan and referrals provided

Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care

Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan

Accountable to understand role and how it affects utilization management benchmarks and quality outcomes

Required Qualifications:


RN or Bachelor's level degree in Social Work or other related field

A current active RN or Social Worker license in the state

Minimum of 1 year clinical or case management experience

Minimum of 1 year experience in long-term care, home health, hospice, public health, clinic, acute care or assisted living

Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area
Preferred Qualifications:


Medicare / Medicaid experience

A background working in geriatric special needs

A background working in pediatric special needs  

A background in behavioral health

Experience with electronic charting

Ability to multitask

Basic level of proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)
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.(sm)
 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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, RN, Registered Nurse, SW, Social Worker, LMSW, LCSW, Bachelor's degree, Care Coordinator, Medicaid, Medicare, Managed Care, Santa Fe, New Mexico, NM