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SCA Call Center Nurse/RN Case Manager

1 month ago

Eden Prairie, Minnesota, United States Optum Full time

This position will assess and coordinate care for a very diverse population of members of the World Trade Center (WTC) Health Program throughout the United States. Educate and inform members of program coverage and limitations while ensuring that high quality and cost-effective care is provided within contract requirements. Use critical thinking and problem solving skills to navigate through the complexities of a member's health conditions while maintaining coverage within the program guidelines. Coordinate health care services for members. Prepare and summarize medical history information on members to present to the Medical Director. Cultivate relationships with members, providers, co-workers, and other team members to ensure program compliance and member satisfaction. 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.

Schedule: This position is Monday - Friday from 9:30 a.m. - 6:00 p.m. EST

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

Primary Responsibilities:

  • Manage an assigned caseload which entails assessment, education and coordination of care for members/health care providers throughout the United States telephonically while keeping a detailed medical record within internal database. Establish and maintain regular contact with members, providers and department supervision
  • Manage inbound and outbound calls from providers to prior authorize tests and procedures related to members' certified health conditions and program coverage
  • Review medical records (monitoring, treatment and supportive) to determine WTC relatedness for potential program coverage and communicate results to members
  • Completion of system generated tasks, including documenting all results as required in internal database (MedNet)
  • Prepare comprehensive reviews and summaries for medical appeals, determination of coverages, and requests for treatment services
    Point of contact for internal departments to answer questions relative to members of their assigned caseload
  • Completion of medical health questionnaires in times of reduced coverage

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 RN license or able to obtain RN licensure in the state in which work is conducted or a compact state
  • 4+ years of clinical experience
  • Experience with Microsoft Office programs
  • Equivalent combination of education, experience and/or applicable military experience will be considered
  • Proven effective interpersonal, communication, and problem solving skills
  • Proven to possess and demonstrate excellent organizational and multi-tasking abilities
  • Proven solid telephone communication skills
  • Proven ability to work independently as well as on a team
  • Proven ability to take initiative and be detail-orientated
  • Proven ability to implement critical thinking and decision making skills in order to identify appropriate care/treatment plans for a wide range of members from low to high complexity

Preferred Qualifications:

  • National Career Readiness Certificate
  • Case Management experience
  • Military healthcare experience
  • Medical call center experience or medical related experience in a corporate/business setting
  • Behavioral health, occupational health or medical/surgical background
  • Knowledge of ICD and CPT coding
  • URAC/ISO experience/knowledge

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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