Field RN Case Manager - Cincinnati, OH - Full-time / Part-time

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)  
   
This is a field based position traveling to provider offices throughout the Cincinnati, OH area. You will be responsible to review charts (paper and electronic - EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. You will be working at the provider office on a daily basis. This position is Monday - Friday during business hours.   
   
Apply for this position with your eyes wide open. Click here to view the Realistic Job Preview: http://uhg.hr/Field_Based_Case_Manager_UHCCS  
   
Primary Responsibilities:    


Primarily provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation
Conducts face to face and telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols
Determines member's overall bio-psychosocial needs and develops individualized member service/care plan based on assessment data, member and caregiver/ stakeholder input, and cost-effective options for service delivery
Provides options and choices for long-term care community or facility-based service delivery
Develops member goals in coordination with member and provider
Routinely and as needed evaluates the effectiveness of the care/service plan and makes appropriate revisions per policy, procedure and state contractual requirements
Facilitates care setting transitions and access to special programs (e.g. Hospital to Home, Advanced Illness, transition from Nursing Facility to community setting)
Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness
Coordinates benefits through other available payment sources
Assists the member to access community, Medicare, family and other third-party resources as appropriate
Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
Provides education to members regarding health care needs, available benefits and services
Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care
Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address
Documents all care coordination activities and interventions in the member's health plan clinical record
Maintains a focus on timely, high-quality customer service
Maintains the confidentiality of all sensitive information
Primarily provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation
Conducts face to face and telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols
Determines member's overall bio-psychosocial needs and develops individualized member service/care plan based on assessment data, member and caregiver/ stakeholder input, and cost-effective options for service delivery
Provides options and choices for long –term care community or facility-based service delivery
Develops member goals in coordination with member and provider
Routinely and as needed evaluates the effectiveness of the care/service plan and makes appropriate revisions per policy & procedure/ state contractual requirements
Facilitates care setting transitions and access to special programs (e.g. Hospital to Home, Advanced Illness, transition from Nursing Facility to community setting)
Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness
Coordinates benefits through other available payment sources
Assists the member to access community, Medicare, family and other third-party resources as appropriate
Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
Provides education to members regarding health care needs, available benefits and services
Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care
Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address
Documents all care coordination activities and interventions in the member's health plan clinical record
Maintains a focus on timely, high-quality customer service
Maintains the confidentiality of all sensitive information    

Required Qualifications:


Current, unrestricted RN license in the State
Reliable transportation, valid and unrestricted driver's license, proof of insurance and ability to travel to provider offices, member homes or other locations within service delivery area
Minimum of 3 years clinical experience in a hospital, acute care, home health, 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
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
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
Must be able to travel to provider offices within service area (up to an hour radius)
Preferred Qualifications:

Bachelors of Science in Nursing
Case Management experience including Certification in Case Management
Experience in intensive care (ICU) or emergency department (ER) nursing
Prior Physician Office experience
Home care/field based case management
Medicaid, Medicare, Managed Care experience
Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
Call Center experience
Experience in working with patients in Home and/or Community based setting
Experience with HEDIS and EMR (electronic medical records)
Experience with navigating and analyzing reports in Microsoft Excel
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity 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.
 
 
Job Keywords: Case Manager, nurse, RN, registered nurse, MCO, managed care, chart review, wellness, provider, CCM, HEDIS, Stars, Medicare, Cincinnati, OH, Ohio