RN Telephonic Service Coordinator, Pediatrics - Sugar Land, TX

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. A passion for excellence you won't find anywhere else. We ask tough questions. We push ourselves and each other to find smarter solutions. The result is a culture of performance that's driving the health care industry forward. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work.(sm)

As a Case Management RN, you will drive positive outcomes by supporting a diverse member population with education, advocacy and the connections to the resources they need.

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.

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In your role as a Telephonic Case Manager, you will:   

• Make outbound calls to assess members' current health status


• Identify gaps or barriers in treatment plans


• Provide patient education to assist with self management


• Interact with Medical Directors on challenging cases


• Coordinate care for members


• Make referrals to outside sources


• Coordinate services as needed (home health, DME, etc.)


• Educate members on disease processes


• Encourage members to make healthy lifestyle changes


• Document and track findings


• Utilize Milliman criteria to determine if patients are in the correct hospital setting


• Make Welcome Home calls to ensure that discharged member receive the necessary services and resources

Required Qualifications:

• Current, unrestricted RN license in the State


• 2+ years experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company


• Ability to navigate a Windows environment, utilize Outlook,  and the ability to create, edit, save and send documents utilizing Microsoft Word

Preferred Qualifications:

• Bachelor's Degree


• A background in managed care


• Case Management experience


• Certified Case Manager (CCM)


• Experience/exposure with discharge planning


• Experience in utilization review, concurrent review and/or risk management


• Strong organizational skills and multitasking abilities will be keys to success

 
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)