Remote Hybrid Private Duty Nurse Care Manager – Northern Virginia

Requisition Number: 2188444
Job Category: Medical & Clinical Operations
Primary Location: Arlington, VA
(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 to start Caring. Connecting. Growing together. 

If you are located in Arlington, VA, Alexandria, VA, Winchester, VA, Falls Church, VA, and Leesburg, VA, you will have the flexibility to work remotely* as you take on some tough challenges

Primary Responsibilities: 

• Meeting contractual requirements related to Initial HRA, MMHS Screening, ICPs, ICT, and minimum mandatory contacts
• Conducting face-to-face visits
• Responsible for oversight of PDN authorizations, including Utilization Management aspects of the authorization process
• Oversight of HCBS UM authorizations
• Participate in PDN Pod Rounds
• Provide primary case management across the continuum for these medically fragile and complex members to include following members through inpatient hospitalizations, assisting with transitions of care, and coordinating HCBS service needs (DME, EM/AT, PC/AC hours, and PDN hours)
• Serve as lead contributor to the oversight of and accountability for member-specific quality measures (HEDIS, NCQA) (will have support and assistance from Quality Department)

**This is a field-based role that will require travel approximately 50% of the time in the field within an assigned coverage area.  Candidates must be willing to travel throughout the state of Virginia; primarily in Northern and Central Virginia area.***

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: 

• Bachelor’s degree in nursing
• Current, unrestricted RN license for the state of Virginia
• 1+ years of care coordination and/or work in a healthcare environment
• Demonstrated competence in applying processes designed to ensure adherence to all pertinent federal and state rules and regulations
• Proven sensitivity to the special needs of children who rely on technology and their families, to include understanding the stress and challenges they may experience
• Proven performance in meeting requirements for HRA completion, managing members with complex health care needs, and ability to manage complex workload

Preferred Qualifications:  

• Experience with PDN authorizations
• Experience with LTSS authorizations
• Experience with Case Management
• Experience with Pediatric Home Health or Private Duty Nursing

Soft Skills:

• Excellent problem-solving ability, organizational skills, and capacity to work independently or as a team
• Excellent work ethic and attention to detail
• Understanding of the importance of bringing quality considerations into every touch point

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