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Clinical Operations Specialist
2 months ago
We are seeking a highly skilled and experienced Nurse Case Manager to join our team at UnitedHealth Group. As a key member of our clinical operations team, you will play a critical role in ensuring the delivery of high-quality patient care and services.
Key Responsibilities- Engage with patients, families, and caregivers to develop and implement comprehensive care plans that meet their unique needs and goals.
- Provide education and support to patients and their families to promote self-management and disease prevention.
- Collaborate with interdisciplinary care teams to identify and address health care gaps and develop strategies to improve patient outcomes.
- Utilize evidence-based practice and clinical expertise to develop and implement interventions that promote positive patient outcomes.
- Provide timely and accurate documentation of patient care and services in accordance with regulatory requirements and company policies.
- Licensed Practical/Vocational Nurse (LPN/LVN) with current, unrestricted license in the state of employment.
- 2+ years of managed care and/or case management experience, with a strong background in clinical operations and patient care.
- Knowledge of managed care, medical terminology, referral processes, claims, and ICD-10 codes.
- Excellent verbal and written communication skills, with the ability to work effectively with patients, families, and healthcare professionals.
- Case Management certification.
- Knowledge of utilization management and/or insurance review processes, as well as current standards of care.
- Proficient computer skills in Microsoft applications and Microsoft Excel.
- Proven skill in planning, organizing, conflict resolution, negotiation, and interpersonal skills to work effectively in a fast-paced clinical environment.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe that everyone deserves access to high-quality, affordable healthcare, and we are committed to making a positive impact in the communities we serve.
We are an equal opportunity employer and welcome applications from diverse candidates who share our commitment to excellence and our values of compassion, integrity, and respect.
