Remote Nurse Case Manager – Remote in WV or surrounding states

UnitedHealthcare

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Requisition Number: 2204553
Job Category: Nursing
Primary Location: Charleston, WV
(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. 

 

Coordinates and manages selected disability claims, assists in assessment, planning, implementation, coordination, monitoring, and evaluation of appropriate health, wellness, and disability management programs in order to augment recovery and return to productivity or to the highest level of function in an efficient, cost-effective manner

 

If you are located in West Virginia, you will have the flexibility to work remotely* as you take on some tough challenges. The schedule for this position is Monday – Friday, 7:30 -4:30 or 8:00 -5:00.

 

Primary Responsibilities: 

  • Assists in selection of appropriate cases and nurse case management intervention as indicated
  • Coordinates communication and contact with and among the recovering worker, his/her support system, the client, physicians, third party administrators, regulatory agencies, and other professionals to collect and access data with which to identify needs and treatment options as needed
  • Reviews past history and incorporates the findings into a current case management plan so as to identify potential problems or barriers, such as environmental, physical, psychosocial, and how they affect recovery
  • Develops a recovering worker’s individualized case management plan with the employer, healthcare providers, and other professional providers to monitor for progress, compliance, complications, consensus, etc., and modify as needed to help establish realistic, time-specific goals
  • Reviews, modifies, and implements the individualized case action plan with parties involved in a manner that empowers the recovering worker to become an active participant in the recovery process and to return to work; also remains accessible to support these efforts
  • Confers with and verbally reports results to internal and external parties, keeping protected health information on a need-to-know basis only
  • Facilitates authorizations and appointments on a timely basis and follow-up for outcome
  • If indicated, devises confidential written initial and progress reports maintained in SmartCasualtyClaims files and are provided to the client as requested.
  • Assists in providing internal employee training regarding the mission of nurse case management and to develop nurse case management case selection skills
  • Monitors case costs for appropriateness and efficiency to ensure optimal medical services are being provided in a cost-effective manner
  • Evaluates the work environment or coordinates efforts for evaluation of work environment to coordinate the earliest appropriate return to work or to achieve team consensus for modified, transitional, or alternative job duties, if appropriate
  • Serves as medical resource person to internal and external personnel to provide information relative to claims or other medical issues
  • May recommend referral for utilization review for medical necessity as related to standard treatment guidelines and regulatory requirements
  • Provides new services that are based on company needs, which are consistent with clinical expertise
  • Prepares for and attends client and/or internal meetings as indicate

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: 

  • Associates of science degree in applied nursing, or a diploma from an accredited school of nursing, or a bachelor’s degree in nursing, or higher levels of education in the field of nursing
  • Current valid West Virginia Registered Nurse licensure
  • Valid driver’s license and personal vehicle accessibility
  • Must complete continuing education designated by RN licensure and applicable certifications

Preferred Qualifications:  

  • License to practice in bordering states
  • CCM or equivalent
  • Basic knowledge of the workers’ compensation policies and procedures and medical resources
  • Basic knowledge of short-term disability case management
  • Basic knowledge of Family Medical Leave Act of 1993 (FMLA)
  • Ability to work independently on a continuing basis
  • Ability to travel and provide own transportation
  • Excellent verbal and written communication skills; ability to communicate and coordinate with recovering workers, their employers, medical providers, and all involved parties to facilitate a medical case management plan
  • Excellent time management and organizational skills
  • Decision-making skills
  • Basic computer skills
  • Self-motivation, timeliness, and flexibility in response to change

 

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

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.