Clinical Care Manager

1 week ago

Inverness, Montana, United States UnitedHealthcare Full time
Job Summary:

As a Clinical Care Manager, you will play a vital role in supporting members with complex medical needs. Your primary responsibility will be to manage the care of these members, working closely with healthcare providers and other stakeholders to ensure they receive the necessary services and interventions. This is an exciting opportunity for a skilled clinician who is passionate about delivering high-quality care and making a meaningful impact on people's lives.

About UnitedHealthcare:

UnitedHealthcare is a leading health insurance company dedicated to improving the health and well-being of its customers. Our mission is to make the health system work better for everyone, and we are committed to providing our members with access to quality care and support services. As a member of our team, you will have the opportunity to work with a talented group of professionals who share your passion for delivering exceptional patient care.

Responsibilities:

* Serve as primary care manager for members with complex medical needs
* Engage members through various modalities (face-to-face or telephonically) to complete a comprehensive needs assessment, including evaluation of medical, behavioral, functional, cultural, socioeconomic, and social determinants of health needs
* Develop and implement person-centered care plans to address needs, including management of chronic health conditions, health promotion, wellness, social determinants of health, medication management, and member safety, in alignment with evidence-based guidelines
* Partner and collaborate with internal care teams, providers, community resources/partners, and leverage expertise to implement care plans
* Monitor and update care plans, incorporating feedback from members to monitor compliance with interventions to achieve care plan goals
* Provide education and coaching to support:
• Member self-management of care needs, in alignment with evidence-based guidelines
• Lifestyle changes to promote health, such as smoking cessation, weight management, exercise
• Assist members in developing personal wellness plans/health crisis plans
* Perform targeted activities and provide education to support HEDIS/STAR gap closure, including scheduling, reminding, and verification of appointments to receive specific services
* Monitor compliance with medication regimens and make referrals to pharmacists for medication reviews and recommendations
* Reassess and update care plans with changes in condition or care needs
* Support proactive discharge planning and manage/coordinate care transitions following ER visits, inpatient admissions, or Skilled Nursing Facility (SNF) admissions
* Access and coordinate Medicaid benefits to support care needs
* Document all care management/coordination activities in clinical care management records

Requirements:

* Current, unrestricted, independent licensure as a Registered Nurse
* 4+ years of relevant clinical work experience
* 3+ years of experience managing the needs of complex populations (e.g., Medicare, Medicaid)
* 1+ year of community case management experience coordinating care for individuals with complex needs
* Demonstrated knowledge of Medicare and Medicaid benefits
* Ability to travel 25% of the time for this role
* Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information and live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or leverage an existing high-speed internet service

Compensation and Benefits:

The estimated salary for this position is $85,000 per year, based on the title, job description, and location. Additionally, you can expect a range of benefits, including paid time off, medical plan options, dental and vision coverage, life insurance, short-term and long-term disability coverage, 401(k) savings plan, employee stock purchase plan, education reimbursement, employee discounts, employee assistance program, employee referral bonus program, and voluntary benefits such as pet insurance, legal insurance, and long-term care insurance. Please note that the compensation package may vary depending on individual qualifications and circumstances.

Why Join Us?

We offer a dynamic and supportive work environment, with opportunities for professional growth and development. Our employees enjoy competitive salaries, comprehensive benefits, and recognition programs. We prioritize diversity, equity, and inclusion, and strive to create a workplace culture that values and respects all employees. If you are passionate about delivering exceptional patient care and making a meaningful impact on people's lives, we encourage you to apply for this exciting opportunity.

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