Remote HSS Clinical Coordinator RN – Baton Rouge, LA

Requisition Number: 2167786
Job Category: Medical & Clinical Operations
Primary Location: Baton Rouge, LA
(Remote considered)

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.(sm)

As a Case Manager, you’ll wear many hats, and work in a variety of environments. Sometimes, you’ll interact with members leaving the hospital – possibly with new medications or diagnoses. Or perhaps you’ll assist members with safe, effective transitions from care environments to where they live. You may also act as an intermediary between providers and members – serving in numerous roles, such as educator, evaluator, service coordinator, community resource researcher and more. The result? Fewer hospitalizations, ER visits and costly service gaps; and a less stressed, more effective health care system for us all. Want more flexibility, want more autonomy?

This position could include some community-based work that could require you to travel occasionally or more frequently in the future to member homes around your local area.

Primary Responsibilities:

• Provide a complete continuum of quality care through close communication with members via on-phone interaction
• Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
• Assist members with the transition from a care facility back to their home
• Providing full Case Management services for disabled members approved for EPSDT PCS, PDN & PDHC including: (EPSDT PCS = Early Periodic Screening Diagnostic Treatment Personal Care Services/PDN = Private Duty Nursing/PDHC = Pediatric Day Health Care)
  • Assessing needs
  • Establishing a plan of care
  • Service coordination
  • Community resource utilization
  • Implementing the plan of care
  • Evaluating the plan of care for effectiveness
  • Serve as a resource to members and their families/caregivers
  • Serve as a resource for providers
• Full management of prior authorization requests for EPSDT PCS, PDN & PDHC
• Clinical Audits of weekly/monthly/quarterly reports for compliance and reporting responsibilities for specialty populations
• Clinical Project Management
• Any other duty assigned by the Manager, Director of Clinical Services, Medical Director, Compliance Officer

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Current, unrestricted RN license in the State of LA
• 3+ years of hands-on clinical experience
• Case Management experience
• Outpatient Prior Authorization/Outpatient Utilization Management experience
• Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications such as Microsoft Word and Excel
• Reside in the state of LA
• Willing to travel up to 25% within the State of Louisiana

Preferred Qualifications:

• Certification in Case Management
• Experience in a Managed Care environment and preferably Medicaid Managed Care
• Pediatric nursing experience
• Experience in Behavioral Health field
• Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
• Experience in Home & Community based or Long-Term Care services delivery
• Experience with coordination of benefits and working with primary and secondary insurance benefits
• Knowledge of ICUE and Community Care
• Bilingual skills

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)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy