Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)As a Case Manager, you'll wear many hats, and work in a variety of environments. Sometimes, you'll interact with members leaving the hospital - possibly with new medications or diagnoses. Or perhaps you'll perform outreach, assisting members with safe, effective transitions from care environments to where they live. You may also act as an intermediary between providers and members - serving in numerous roles, such as educator, evaluator, service coordinator, community resource researcher and more. The result? Fewer hospitalizations, ER visits and costly service gaps; and a less stressed, more effective health care system for us all. Want more flexibility, want more autonomy? Work from your own home and coordinate a visiting schedule that is mutually beneficial to you and the members we serve.What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. The ability to travel in state 25% of the time Will work Onsite at: 795 Woodlands Parkway, Suite 301 Ridgeland MS 39157Primary Responsibilities: Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction Will be responsible for state data collection analysis and reporting Support members with condition education, medication reviews and connections to community resources Assist members with the transition from a care facility back to their home Position is required to be onsite at health plan with ability to telecommute and participate in member and provider outreach at management discretion. Participate in clinical quality initiatives Responsible for care management program evaluation Reviewing and responding to appeals and general inquiries and state inquiriesPerform/Assist with provider and member outreach as neededMonitor and facilitate care coordination activities through shared service partners.
Required Qualifications: Current, unrestricted RN license in the State 3+ years clinical experience in a hospital, acute care, home health / hospice, direct care or case management Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others Preferred Qualifications: Case Management experience including Certification in Case Management Home care / field based case management Medicaid, Medicare, Managed Care experience Experience working with the needs of vulnerable populations who have chronic or complex bio - psychosocial needs Bilingual skills Experience in Home & Community based or Long Term Care services deliveryCareers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: Case manager, Medicare, Medicaid, Certified Case management, CCM, Disease, Home care, management, Long term care, managed care, clinical, telephonic, Milliman Criteria
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.