Remote RN Care Manager Complex Case Management

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Requisition Number: 2198570
Job Category: Nursing
Primary Location: Seattle, WA
(Remote considered)

$10,000 Sign On Bonus for External Candidates

 

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

The Case Manager – Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual member needs.  The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of case management, utilization review/management and discharge planning.  It is the purpose of the Case Manager to ensure that the psychosocial needs of the members are met. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Case management services may be provided telephonically in the provider office or at member’s home.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

  • Develop a comprehensive care management plan that will address member’s individual needs which includes specific objectives, goals and actions
  • Prioritizes member care needs upon initial assessment and addresses emerging issues
  • Assist members in the management of illness and treatment, monitoring adherence, and proactively investigating and addressing problems that may contribute to non-adherence with the member and other members of the multidisciplinary team
  • Assesses reports, data, and other health plan information to identify potential members in need of case management intervention
  • Decreases healthcare costs of enrollees by working collaboratively with the case management team to assist members in managing visits to Primary Care Providers offices, decrease ER Utilization, number of hospitalizations, and number of readmits to hospital, skilled nursing facilities and home health
  • Monitor the effectiveness of the care management plan and short/long term goals and adjust per member need
  • Assesses and prioritizes case referrals to assure health plan requirements for outreach and engagement are within expected time frames
  • Provides member and family education, support and encouragement, especially to enhance adherence to treatment regimen and follow up care
  • Develops communication protocols with physicians in the network, clinic and community so that early notification and intervention by the case management team occurs for members
  • Keeps current on areas of case management, quality management, utilization management, member education and preventive health guidelines
  • Provides recommendations and assists in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelines
  • Acts as liaison and member advocate with other care providers
  • Participate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference)
  • Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomes
  • Develops an effective support system within the family and community to manage emergency situations and to provide support and safety for the member
  • Acts to prevent suicide and homicide in accordance with state licensure requirements.
  • Compiles information from workload and other statistical data to prepare reports that demonstrate health care trends within member population
  • Coordinates with Behavioral Health Case Manager on cases with mental health component, dual manage as necessary

 

Duties listed below are integrated into all job functions:

  • All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and members
  • Must relate to other people beyond giving and receiving instructions: (a) get along with co-workers or peers without exhibiting behavioral extreme; (b) perform work activities requiring negotiating, instructing, supervising, persuading or speaking with others; and (c) respond openly and appropriately to feedback regarding performance from a supervisor
  • Performs all duties in a manner which promotes and supports the Core Values and Mission Statement
  • Integrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfaction
  • Frequently must follow written and oral instructions as well as complete routine tasks independently
  • Completes annual compliance training
  • Attends training to meet requirements of the job position and as needed or mandated
  • Working knowledge of health care delivery systems
  • Work as an interdisciplinary team member with members, physicians, administration, staff and other managers
  • Other duties as assigned

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: 

  • RN, BSN or above preferably from accredited nursing program
  • Current unrestricted nursing license for the State of Washington
  • 2+ years of broad-based clinical experience

 

Preferred Qualifications: 

  • Case Management certificate, will be mandatory after two years of employment

Knowledge Skills and Abilities:

  • Working knowledge of health care delivery systems
  • Demonstrate knowledge of PC applications including MS Office Suite
  • Ability to use written and oral communication skills
  • Ability to read and interpret data
  • Skill in writing clear, grammatically correct, easy–to-use instructional documentation
  • Ability to identify learning needs, set goals and seek educational opportunities
  • Ability to analyze problems and formulate appropriate plans, solutions and courses of action
  • Knowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally
  • Ability to work with frequent interruptions
  • Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates
  • Ability to maintain confidentiality of member and all related entity business matters of the organization and its partners
  • Ability to manage detail and work with accuracy
  • Ability to recognize and act appropriately in situations where member care needs exceed medical certification
  • Skill in working with a team; ability to collaborate on projects with colleagues
  • Skill in working effectively under deadlines and changing priorities

 

Mental & Physical Requirements:

  • Must be able to work effectively as a member of team; work is detailed and complex with multiple competing priorities, deadlines and internal and external customers
  • Must be able to frequently stand, walk for short to long periods with intermittent breaks, frequent use hands, fingers with prominent computer work. May have periods of prolonged sitting in connection with telephone and computer usage. Demonstrate proper body mechanics to support physical activity during workday
  • Work is performed remotely in an office setting. May be required outside normal business hours. Work may be demanding at times.  May require ability to work irregular hours

 

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

 

Washington Residents Only: The salary range for Washington residents is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.