Clinical Care Manager

13 hours ago

Miami, United States UnitedHealth Group Full time

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.

This position will be the primary care manager for a panel of members with primary complex medical needs. The Care Management / coordination activities will focus on supporting member‘s medical, behavioral and socioeconomic needs to promote appropriate utilization of services and improved quality of care. All case management/ coordination activities will be in alignment with evidence-based guidelines. This position will liaison with the members‘ provider community to help reduce fragmentation within the care ecosystem. The role will provide medically oriented clinical consults/guidance within the team and to other area within the health plan. The Clinical Care Manager will approach their member work with an understanding of how inequities drive health disparities. They will promote health equity.

If you live in FL, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Serve as primary care manager for members with primary complex medical needs
  • Engage members through a variety of modalities (face and/or telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs
  • Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
  • Partner and collaborate with internal care team, providers, community resources/partners and leverage expertise to implement care plan
  • Monitor and update care plan, incorporating feedback from member to monitor compliance with interventions to achieve care plan goals
  • Provide education and coaching to support:
    • Member self-management of care needs in alignment with evidence-based guidelines
    • Lifestyle changes to promote health, i.e. smoking cessation, weight management, exercise
  • Assist member in development of personal wellness plan / health crisis plan
  • Perform targeted activities and provide education to support HEDIS/STAR gap closure, including scheduling, reminding and verification of appointment to receive specific services
  • Monitor compliance with medication regimen and make referrals to Pharmacist for medication review and recommendations
  • Reassess and update care plan with change in condition or care needs
  • Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
  • Access and Coordinate Medicaid Benefits to support care needs
  • Document all care management/coordination activity in clinical care management record

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, unrestricted, independent licensure as a Registered Nurse
  • 4+ years of relevant clinical work experience
  • 3+ years of experience managing needs of complex populations (eg. Medicare, Medicaid)
  • 1+ years of community case management experience coordinating care for individuals with complex needs
  • Knowledge of Medicare and Medicaid benefits
  • Proven to possess a solid work ethic
  • Proven to possess a positive and motivated attitude
  • Proven ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner
  • Proven ability to adapt to change in the workplace
  • Proven ability to work independently and as a part of a team
  • Proven ability to interact with internal and external customers in a corporate environment
  • Willingness to adapt to multiple external environments and settings

Preferred Qualifications:

  • Master‘s degree in nursing or related clinical field
  • Experience working with behavioral health issues that can be applied to help guide and support member‘s with behavioral health needs
  • Experience working in team-based care
  • Experience working in Managed Care
  • Lived experience (self or family) in managing or overcoming a chronic health, behavioral health or substance use condition
  • Bilingual in (Spanish)

Physical Requirements and Work Environment

  • Ability to transition from office to field locations multiple times a day
  • Must possess transportation to visit clients in various locations
  • Ability to travel varied distances and multiple terrains to visit assigned client locations
  • Ability to carry equipment to and from field locations needed for face to face member visits (ex. laptop, stethoscope, blood pressure cuff, etc.)

*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.


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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