$70200 - $137800 Year
Monday to Friday
Day shift
Health insurance
Paid time off
Employee discount
Dental insurance
Vision insurance
401(k)
401(k) matching
Flexible schedule
Parental Leave
Tuition reimbursement
Flexible spending account
Retirement plan
Positions in this function facilitates a team approach to ensure cost-effective delivery of quality care and services based on medical conditions and social determinants. Collaborates with members, providers, and other resources to assess, plan, implement, coordinate, monitor and evaluate options and services required to meet an individual’s healthcare needs. Promotes member’s goals for self management, facilitates effective health care system navigation, reduces gaps in care, and provides support and community resources as needed. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures and regulations to ensure compliance and patient safety.
Primary Responsibilities:
Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member’s health, social determinants, and gaps in care
Creates and implements a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient’s needs and goals
Performs ongoing updates of the care plan to evaluate effectiveness, and to document barriers, interventions, and goal achievement
Partners with primary providers or multidisciplinary team members to align or integrate goals to plan of care
Completes home, facility, clinic and telephonic visits for member engagement and enrollment
Uses motivational interviewing to evaluate, educate, support, and motivate change during member contacts
Identify and consider appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
Ensures compliance with quality metrics specific to health plan delegation and accrediting body requirements
Conducts self and peer audits
Maintains caseload per defined medical management department standards
Sustains productivity and audit requirements per medical management department standards
Demonstrates ability to work independently and implement innovative approaches to complex member situations
Sought out as expert and serves as leader/mentor to other members of medical management team
Determines need for continued member management, creates care plan and facilitates transition to medical management programs
Serves as facilitator and resource for other members of the Medical Group clinical team
Attends departmental meetings and provides constructive recommendations for process improvement
Performs 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:
Associates Degree in Nursing
Valid NV RN License
Current BLS Certification
3+ years of previous job-related experience in a healthcare environment
Preferred Qualifications:
Bachelor’s degree or higher in healthcare related field
Case Management Certification
3+ years of experience providing case management and/or utilization review functions within health plan or integrated system
Knowledge/Skills/Abilities:
Excellent communication, interpersonal, organization and customer service skills
Self-motivated, attention to detail
Ability to multi-task and work under pressure
Demonstrates knowledge of computer functionality and software applications (e.g., navigating systems, troubleshooting, electronic charting, accessing intranet and record management databases)
Demonstrate knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, commercial) or regulatory bodies (e.g.,NCQA)
Demonstrate understanding of relevant health care benefit plans
Physical Demands:
Rarely (Less than .5 hours/day)
Occasionally (0.6 – 2.5 hours/day)
Frequently (2.6 – 5.5 hours/day)
Nevada Residents Only: The salary range for Nevada residents is $70,200 to $137,800 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.
Communication
Leadership
Teamwork
Interpersonal
Learning/adaptability
Self-management
Organizational
Computer
Problem solving
Open mindedness
Strong work ethic
technology
3+ years of previous job-related experience in a healthcare environment
Associates Degree in Nursing
Valid NV RN License
Current BLS Certification
Health care
3
Remote