TRICARE Pediatric RN Case Manager, Phoenix, Arizona

Talk about meaningful work.  Talk about an important role.  Let's talk about your next career move.  Our UnitedHealthcare Military & Veterans organization has been selected to provide quality health care services for those who serve our nation.  This is an opportunity to share in something special; an opportunity for all of us to serve those families who have made our nation stronger. It's an inspiring role and it can inspire your career.  Find out more about these opportunities to do your life's best work.(sm)
 
The RN Case Manager is responsible for case management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating.  The RN provides telephonic case management support of TRICARE beneficiaries and families. 
The Case Manager educates and supports the parents and the family through telephonic assessment and interventions.  The RN collaborates with hospital staff and other providers and programs to enhance quality and efficiency in healthcare delivery.  Identifies gaps in care and HEDIS measures and coaches family to help beneficiary to close these gaps in care.  The Case Manager develops a plan of care in collaboration with Parents and family and other providers.  Coordinates services as needed (home health, DME, etc.)  The RN assesses the effectiveness and quality of services provided and works with parents and family to adjust services as needed.
This is an office position located at 2222 West Dunlap Ave, Phoenix, Arizona; or to be considered for a telecommuter position, candidate must have previously or currently worked in a telecommuter position.  
Primary Responsibilities:

Educating and supporting the parents and family unit through telephonic assessment and expert clinical interventions Identifying gaps or barriers in treatment plans  
Document all clinical information in accordance with UnitedHealthcare Military & Veterans policies and procedures
Providing patient education to parent and family to assist beneficiary with self-management 
Assess and interprets beneficiary needs, gaps, and requirements
Leads efforts to provide specialized case management services to beneficiaries identified with very complex conditions or diseases requiring intensive and extensive coordination of
resources including accessing Centers of Excellence with specialty hospitals, multiple specialists and sub-specialists, DME, home care and therapy providers.
Solves moderately complex problems and/ or conducts moderately complex analyses
Develops plan of care in collaboration with beneficiary/caregiver/provider
Works with minimal guidance, seeks guidance on only the most complex tasks
Translates concepts into practice
Provides explanations and information to others on difficult issues
Collaborates with specialists, physicians, and medical directors to provide the necessary care and cost efficient care for the beneficiary
Assesses the effectiveness and quality of services provided related to clinical, functional, and financial impact and outcomes
Maximizes use of community services, support programs, and resources available to beneficiary

Required Qualifications:

Current, unrestricted RN license in Arizona
3+ years clinical experience in acute care, direct care, ER or hospital setting
3+ years of experience in Pediatrics or NICU
3+ years of Case Management experience
Intermediate experience with Microsoft Word, with the ability to navigate a Windows environment
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
United States Citizenship
Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86
Preferred Qualifications:

Bachelor’s Degree
Case Management Certification (CCM) preferred or may obtain within 18 months
Previous experience working with Tricare, Military and Veterans
As a requirement of UnitedHealth Group’s contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense eQuip Form SF86, (the National Agency Check Legal and Credit or NACLC).  Successful completion of the NACLC process is a requirement for continued employment in this role.  NACLC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense.  Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received.  Failure to obtain final NACLC approval will result in termination from this role.Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. That's why UnitedHealthcare is the organization that's called on to serve them and their loved ones. We're all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. It's a genuine opportunity 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: Registered Nurse, Nurse, RN, Tricare, military, veterans, CM, case management, CCM, Pediatrics, Peds, NICU, infant, children, acute care, direct care, ER, hospital, Phoenix, telecommuting, Arizona, AZ