Nurse Case Manager II Position

Opportunities at UnitedHealth Group. We believe all patients are entitled to the highest level of medical care. Here, you will work with a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff, and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

The Nurse Case Manager II is responsible for patient case management for longitudinal engagement, coordination for discharge planning, transition of care needs, and outpatient patient management through the care continuum. This role will identify, screen, track, monitor, and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a patient's action plan and/or discharge plan. They will perform reviews of current inpatient services and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. The Nurse Case Manager will provide continuity of care for members to an appropriate lower level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The Nurse Case Manager will coordinate or provide appropriate levels of care under the direct supervision of an RN Manager or MD. Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching, and treatment decision support for patients. The Nurse Case Manager will act as an advocate for patients and their families, guiding them through the healthcare system for transition planning and longitudinal care. The Nurse Case Manager will work in partnership with an assigned Care Advocate and Social Worker.

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

Primary Responsibilities:

1. Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health status
2. Provide member education to assist with self-management goals; disease management or acute condition and provide indicated contingency plan
3. Identify patient needs, close health care gaps, develop action plan, and prioritize goals
4. Utilizing evidenced-based practice, develop interventions while considering member barriers independently
5. Provide patients with 'welcome home' calls to ensure that discharged patients receive the necessary services and resources according to transition plan
6. Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care
7. Independently serves as the clinical liaison with hospital, clinical, and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria within our documentation system for discharge planning and/or next site of care needs
8. In partnership with care team triad, make referrals to community sources and programs identified for patients
9. Utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
10. Manages assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers
11. Collaborates effectively with Interdisciplinary Care Team (IDCT) to establish an individualized transition plan and/or action plan for patients
12. Independently confers with UM Medical Directors and/or Market Medical Directors on a regular basis regarding inpatient cases and participates in departmental huddles
13. Demonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning activities
14. Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
15. Manage assigned caseload in an efficient and effective manner utilizing time management skills
16. Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 95% or better on a monthly basis
17. Maintain current licensure to work in state of employment and maintain hospital credentialing as indicated
18. Performs all other related 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:

1. Associate's degree in Nursing
2. Current, unrestricted RN license, specific to the state of employment
3. Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
4. 3+ years of diverse clinical experience; preferred in caring for the acutely ill patients with multiple disease conditions
5. 3+ years of managed care and/or case management experience
6. Proven knowledge of utilization management, quality improvement, and discharge planning

Preferred Qualifications:

1. Experience working with psychiatric and geriatric patient populations
2. Ability to read, analyze, and interpret information in medical records, and health plan documents
3. Ability to problem solve and identify community resources
4. Possess planning, organizing, conflict resolution, negotiating, and interpersonal skills
5. Ability to independently utilize critical thinking skills, nursing judgment, and decision-making skills. Ability to prioritize, plan, and handle multiple tasks/demands simultaneously
6. Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel

Physical & Mental Requirements:

1. Ability to lift up to 10 pounds
2. Ability to push or pull heavy objects using up to 25 pounds of force
3. Ability to sit for extended periods of time
4. Ability to stand for extended periods of time
5. Ability to use fine motor skills to operate office equipment and/or machinery
6. Ability to receive and comprehend instructions verbally and/or in writing
7. Ability to use logical reasoning for simple and complex problem solving

UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer. 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.