RN Case Manager

7 hours ago

Sheboygan, Wisconsin, United States UnitedHealth Group Full time
Job Summary

We are seeking a skilled RN Case Manager to join our Optum Home & Community Care team. As a key member of our Senior Community Care product, you will work closely with a team to provide care to patients at home, in nursing homes, and assisted living facilities.

This is a unique opportunity to make a meaningful difference in the lives of our patients and their families. You will function as part of the primary care team, reporting to the Clinical Services Manager (CSM), and work in close collaboration with all interdisciplinary team members.

Key Responsibilities
  • Assist the provider/team with various care coordination activities in the nursing home
  • Assist the provider/team with benefit determination associated with Medicare part A, part B, and part D benefits
  • Collaborate with the primary Advanced Practice Clinician (APC) and nursing facility to identify and respond to patient Change in Condition
  • May assist the provider by completing Decision Support Tool (DST), re-assessing the patient, and other activities as delegated by the provider or the Clinical Services Manager (CSM)
  • Assist the provider/team with therapy coordination for members, including possible assessments or follow-up on requests and communicate and collaborate with APC
  • May perform interval check-in on patient progress with therapy department
  • May participate in facility-based therapy discussion meetings
  • Schedule and participate in family conferences, team meetings, and team case presentations
  • May assist in the coordination of training, tracking, and compliance with quality measures
  • May participate in the onboarding of new clinical staff under the direction of the CSM Manager, which could include coordination of onboarding activities and participation in other orientation activities
  • Participate in facility partnership or Customer Relationship Management (CRM) meetings under the direction of the APC/CSM
  • May assist in coordinating CRM meetings and may participate in and contribute to the meetings
  • May assist the team in tracking LearnSource completion for the team members and CSM
  • Assist in creating and conducting in-services for selected audiences
  • Will document information and activities in the EMR
  • May assist Providers in assuring complete and accurate documentation and coding, medication reconciliation, nursing rounds, assessment, and patient documentation
  • Assist the team/providers in prioritizing advance Care Planning and initiating discussions
  • Collaborates with all key stakeholders, providers, nursing homes, PCPs, families, interdisciplinary care teams, and any other identified stakeholders
  • Review the chart and enter HEDIS/Quality information into the Electronic Medical Record (EMR), communicate gaps to the Provider
  • May write verbal orders from Provider in the chart in compliance with the state RN practice laws and in compliance with individual nursing facility practices
  • Conducting goals of care conversations
What We Offer

We offer a competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

  • Paid Time Off, which you start to accrue with your first pay period, plus 8 Paid Holidays
  • Medical Plan options, along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life & AD&D Insurance, along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
  • More information can be downloaded at: http://uhg.hr/uhgbenefits
Requirements

To be successful in this role, you will need:

  • Associate degree or higher in Nursing (RN)
  • Current unrestricted Registered Nurse license in the state
  • Certified in Basic Life Support
  • Valid Driver's License with access to reliable transportation that will enable you to travel up to 100% to visit clients and/or patient sites within a designated area

We are an equal opportunity employer and welcome applications from diverse candidates. We are committed to creating a workplace that is inclusive and respectful of all employees. If you are passionate about making a difference in the lives of our patients and their families, we encourage you to apply for this exciting opportunity.

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