Complex RN Case Manager, Advantage Plus Network of CT
3 weeks ago
As a RN Case Manager, Complex Care Coordination with UnitedHealth Group, you will play a vital role in coordinating care plans for our members. You will work closely with physicians to ensure that our members receive the best possible care. This is a full-time, 40-hour-per-week position, Monday through Friday, 8:00 AM - 4:30 PM. You will be required to travel to Farmington, CT for training and meetings as needed.
Responsibilities
* Coordinate care plans with physicians and other healthcare professionals to ensure that our members receive the best possible care.
* Work with multidisciplinary teams to maintain and implement up-to-date coordinated care plans.
* Communicate with all members of the healthcare team on behalf of the member.
* Assist physician providers, members, and their families in obtaining referrals to needed specialists.
* Provide support and counseling, as appropriate to the clinical situation.
* Develop and maintain member care plans with designated physicians.
* Proactively participate in the development and deployment of coordination of care activities to improve the clinical experience for referred members and the referring physician.
* Communicate with members of the care team as appropriate to coordinate the identified member and physician's needs.
* Educate member and care team participants on community/health plan benefit services available.
Requirements
* Bachelor's Degree in Nursing (BSN)
* Unrestricted current CT Nursing License
* 2+ years of experience managing complex disease states
* 2+ years of telephonic health plan case management
* Experience with Electronic Health Records (Allscripts, Epic)
* Knowledge and understanding of NCQA/ACO/CDO regulations and standards
* High proficiency with navigating multiple complex computer programs (including but not limited to Microsoft Products, Adobe)
* Ability to travel up to Farmington CT for training and meetings as needed. Possible travel to other locations at times.
Preferred Qualifications
* Master's Degree in Nursing (MSN)
* Certified Case Manager Certification (CCMC)
* 5+ years of experience as a nurse case manager
* 5+ years of experience managing complex disease states
* 2+ years of utilization management or concurrent review experience
* Experience in a remote work setting
* Bilingual with English and Spanish, Polish, Mandarin, or Vietnamese
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