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Registered Nurse Case Manager
2 months ago
We are seeking a highly skilled Registered Nurse Case Manager to join our team at UnitedHealth Group Inc. As a key member of our healthcare team, you will play a vital role in ensuring the highest level of medical care for our patients.
Key Responsibilities- Conduct initial assessments of patients with complex case management needs, identifying clinical, behavioral, social, environmental, and financial factors that impact their care.
- Collaborate with interdisciplinary care teams to establish individualized care plans, prioritizing interventions to achieve short- and long-term goals.
- Engage patients, families, and caregivers to ensure a well-coordinated care plan is established, addressing their unique needs and preferences.
- Develop and implement care plans, utilizing evidence-based practice and considering member barriers, with guidance from medical directors and care management managers.
- Make outbound calls to assess patient health status, identify gaps or barriers in care plans, and provide education to support self-management goals.
- Refer patients to outside sources, educate them on disease processes or acute conditions, and provide contingency plans with guidance from medical directors and care management managers.
- Coordinate visits with primary care physicians and specialists, perform visual assessments for skin checks, and conduct home safety evaluations.
- Enter timely and accurate data into designated care management applications, maintaining audit scores of 90% or better on a monthly basis.
- Adhere to organizational and departmental policies and procedures, taking on-call assignments as directed.
- Maintain current licensure to work in the state of employment, making decisions based on regulatory requirements, policies, and procedures, and current clinical guidelines.
- Monitor for quality concerns regarding patient care and report as per policy and procedure.
- Bachelor's degree in Nursing, and/or Associate's degree in Nursing combined with 2+ years of experience and/or Nursing Diploma.
- Current unrestricted Registered Nurse license, specific to the state of employment.
- Case Management certification (CCM) or ability to obtain CCM within 12 months after the first year of employment.
- 3+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions.
- 2+ years of managed care and/or case management experience.
- Proven knowledge of utilization management, quality improvement, and discharge planning.
- Proficient with Microsoft Office applications, including Outlook, Word, and Excel.
- Proven ability to utilize critical thinking skills, nursing judgment, and decision-making skills, prioritizing, planning, and handling multiple tasks/demands simultaneously.
- Proven ability to read, analyze, interpret information in medical records and health plan documents.
- Proven ability to problem-solve and identify community resources.
- Proven planning, organizing, conflict resolution, negotiating, and interpersonal skills.
- Access to reliable transportation to travel to client and/or patient sites within a designated area.
- This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease.
- Experience working with psychiatric and geriatric patient populations.
- Ability to frequently stand, walk, or sit for long periods.
