RN Field Case Manager in Boston, MA

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) 

The RN Case Manager is a field based role to support public sector population in the state of MA. Working with the geriatric population in the home and community setting concentrating on providing holistic case management services to members who are receiving or may be in need of medical daycare services or personal care assistant services. Will be traveling into member homes and medical daycare settings to conduct in depth assessments and set up plan of care.

RN Case Manager Responsibilities:

•Conduct initial and follow-up assessments within designated timeframes on patients identified as having highest risk complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial)

•Assess the patient's current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatment plan

•Engage patient, family, caregivers, and healthcare providers to assure that a well-coordinated treatment plan is established

•Utilize holistic approaches to patient care and integrates patient's life and motivational goals into the treatment plan

•Prioritize care needs, set goals and develop a treatment plan (or plan of care) that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation

•Track the patient's health status and progress in achieving clinical and personal goals

•Initiate face to face visit and PRN calls when key gaps are identified that require additional nursing follow-up

•Provide education, information, direction, and support related to care goals of patients

•Coordinate acquisition and proper use of medical equipment, initially and on an ongoing basis

•Communicate with patients, families, caregivers, physicians, and other service providers to coordinate the care needs for the patient  

•Work to facilitate patient compliance and to ensure continuity of care

•Monitor and evaluate the patient's response to treatment(s)

•Collaborate with the attending physicians and Medical Director to revise treatment plans as needed

•Document assessments, interventions, and follow-up on disease management activities

•Regularly assess the effectiveness and quality of services provided to patients by analyzing outcomes (clinical, functional, and financial)

•Maintain a focus on timely, quality customer service

•Provides case management and education services in the community, at a provider location or the enrollees home to address gaps in care and unmet needs

•Maintain the confidentiality of sensitive information

•Maintain a focus on the customer service through policy and program decisions and consider impact of these activities on the members

•Facilitate problem resolution with members, providers, and other agencies or entities as needed

Required Qualifications:

•Registered Nurse (RN) with active and unrestricted license in the state of MA

•2+ years of clinical experience to include long-term care, home health care or acute care

•Proficiency in software applications that include, but are not limited to, Microsoft Word and Microsoft Outlook

•Active driver's license and viable transportation to conduct in home member visits within the assigned region

•Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

Preferred Qualifications: 

•Experience providing care coordination to persons receiving long-term care and/or home and community based services

•Experience in managed care

•Experience working in a field based position

•Case Management

•Working knowledge of Medicare regulations

•Bachelor's Degree or higher strongly preferred

•Case Management Certification (CCM)

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: 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, registered nurse, case manager, care manager, care coordinator, home health, hospice, ccm, telecommute,  work from home, Boston