Healthcare Professional
7 days ago
UnitedHealth Group is seeking a skilled Case Manager RN to join our team. As a Case Manager RN, you will play a critical role in driving Referral Management and appropriate sites of service, facilitating Care Transitions and Care for High-Risk patients. You will collaborate with PCP, Specialists, and Spectrum Clinical Pharmacist to ensure appropriate, coordinated service delivery.
Key Responsibilities- Work with a Care Team of a Clinical Pharmacist and Clinical Administrative Coordinator to support patient and provider engagement for Care Transitions Management, Care Coordination, and Medication Therapy Management
- Facilitate inpatient discharge information to Care Team and Primary Care Offices using appropriate technology tools
- Consult with patients who have had an inpatient discharge; facilitate scheduling transitions of care follow-up appointments with PCP and/or specialists
- Consult with patients who have had an ED discharge; facilitate scheduling follow-up appointments as needed; review post-discharge information with patients and educate on alternative sites of care
- Engage high-risk patients telephonically to schedule appointments with Clinical Pharmacist for Comprehensive Medication Reviews
- Prepare patient cases in workflow management platform for Clinical Pharmacist patient engagement
- Consult with patients identified as needing a specialist referral to recommend high-quality, lower-cost specialists
- Support high-risk patients by scheduling PCP and/or specialist appointments on their behalf
- Provide benefit information and resources to patients upon request
- Communicate with provider offices to problem-solve patient issues and/or facilitate communication between practice staff and Care Team
- Notify PCP and Care Team Clinical Pharmacist of relevant clinical information gathered during calls to patient that may affect the patient's disease state or medication regimen
- Develop strong relationships with provider offices participating with Practice Extend program by communicating program goals, patient needs, and value-based opportunities
- Facilitate and/or lead meetings with provider offices for initial onboarding meetings and ongoing collaboration meetings
At UnitedHealth Group, we offer a comprehensive benefits package, competitive pay, and opportunities for career growth and development. Our team is dedicated to helping people live healthier lives and making the health system work better for everyone.
Requirements- Bachelor's Degree (Or Higher)
- Unrestricted licensure as a Registered Nurse for OH, IN, or KY or a compact licensure
- 4+ years of facilitating comprehensive case management and/or care coordination experience
- 3+ years of experience in managing populations with complex medical or behavioral needs
- Intermediate level of proficiency with Microsoft Office, Outlook, and Teams applications, and ability to quickly learn clinical applications and multi-system management
- Intermediate level of ability to type and navigate a Window-based environment simultaneously
- Able to travel up to 10% to local office(s) to accommodate business needs
- Able to work flexible schedule, including evenings up to 7pm, to accommodate business needs
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