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) The RN Care Coordinator is responsible for facilitating, promoting and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The RN Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, efficient, cost effective patient care. The RN Care Coordinator will be traveling into enrollees' homes, nursing facilities, Adult Day Health and Adult Living Facilities (ALF) to conduct in-depth assessments and develop the plan of care. The RN Care Coordinator actively assists enrollees with care transitions in collaboration with the Interdisciplinary Team and the acute or skilled facility staff, and the enrollees and/or the enrollees' representatives RN Care Coordinators act as liaison between the Health Plan, the Commonwealth, enrollees and their families. RN Care Coordinators follow established professional standards of care, Commonwealth guidelines and policy and procedures. We have needs in the following: Alleghany, Bath, Bedford, Botetourt, Craig, Roanoke and Rockbridge. Primary Responsibilities:Conducts initial and follow-up assessments within designated timeframes on enrollees identified as having complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial) Assess the enrollees' current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatment plan Acts as an advocate for patient care needs by identifying and communicating opportunities for care interventions, including identifying and addressing functional deficits and gaps in care Develops a member specific Plan of Care that will be utilized to obtain authorizations for appropriate home and community based services Develops and implements targeted strategies to improve health, functional or quality of life outcomes Serves as a point of contact for Members and the Interdisciplinary Care Team (ICT) of all physical health, behavioral health and other home and community based services Proactively educates enrollees about the program, including consumer direction of Home and Community Based Services Coordinates with the Fiscal Employer Agent (FEA) and Service Facilitator for enrollees who opt for the consumer direction option, as needed Monitors hospitalizations and institutional facility admissions and re-admissions to identify issues and implement strategies to improve outcomes Provides assistance in resolving concerns about service delivery or providers Coordinates with enrollees primary care provider, specialists and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care Routinely assesses and monitors enrollees' status, needs and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to the plan of care, providers and/or services to promote better outcomes Reports quantifiable impact, quality of care and/or quality of life improvements as measured against the care coordination goals Establishes and maintains professional working relations with community resources and care providers Collaborates with peers on enrollees' admissions, transitioning and/or discharge planning Refers service requests that do not meet approval criteria to Manager, Director, or RN for further review and determination Performs other social services-related case management duties as needed
Required Qualifications:Current and unrestricted Registered Nurse License or Certified in the state of Virginia OR hold a multi-state license recognized by Virginia 1+ year experience directly working with individuals with complex medical or behavioral needs 3+ years of care coordination or behavioral health experience and / or work in a healthcare environment Experience working with members who have complex medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers Proficient computer skills in Microsoft Office, to include Excel, Word, Outlook and the ability to type and talk at the same time and toggle between multiple screensPreferred Qualifications:Experience working with Medicaid / Medicare population Long term care / geriatric experience Case management experience in a clinical setting (hospital, long term care, home health, hospice) or managed care Experience providing care coordination to persons receiving long-term care and/or home and community based services Certified Case ManagerCareers 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: RN, nurse, case manager, CCM, Medicaid Waver, behavioral health, public health, community health, long term care, rehab, home care, care coordination, home health, complex case management, managed care, bilingual, VA, Virginia, Alleghany, Bath, Bedford, Botetourt, Craig, Roanoke, Rockbridge, VAMLTSS
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.