Practice Based Support Nurse Case Manager - RN - State of IL
January 13, 2018
This is a field based position traveling to physician practices. Case managers review charts (paper and electronic - EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Case managers primarily work at physician practices on a daily basis. If you are located in Illinois, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:Provides care coordination / case management through physician practices for members to improve clinical quality and clinical documentation. No direct patient careMay conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocolsMay interact with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completedReview member charts prior to a physician appointment and create alerts / triggers to highlight Star opportunities for the practicePartner with the practice's administrative and clinical staff while managing patient appointments and data between visitsCreate and maintain a professional and supportive relationship with the patient, provider and office staff Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social ServicesAssists the member to access community, Medicare, family and other third-party resources as appropriateCollaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the memberProvides education to members regarding health care needs and available servicesWorks to facilitate member compliance with their care / treatment plan and to ensure continuity of careIdentifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to addressDocuments all care coordination activities and interventions in the member's health plan clinical recordMaintains a focus on timely, high-quality customer serviceMaintains the confidentiality of all sensitive info
Required Qualifications:Current, unrestricted RN license in the State of ILReliable transportation, valid and unrestricted drivers license, proof of insurance and ability to travel to provider offices or other locations within service delivery areaMinimum 3 years of clinical experience in a hospital, acute care, home health, direct care or case managementComputer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications including MS Office and ExcelProblem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of actionExcellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from othersMust be able to travel to provider offices within service area - may require up to 1 hour radius for travelDemonstrated ability to identify with a consumer in order to understand and align with their needs and realitiesDemonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respectDemonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s). Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer Preferred Qualifications:Bachelors of Science in NursingCase Management experience including Certification in Case ManagementExperience with HEDIS and EMR (electronic medical records)Experience with navigating and analyzing reports in Microsoft ExcelMedicaid, Medicare, Managed Care experiencePrior Physician Office experience Home care / field based case managementExperience in intensive care (ICU),emergency department (ER) nursing, or Home HealthExperience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needsCall Center experience Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy 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: Registered Nurse, RN, case manager, case management, managed care, field-based, healthcare, health care, Illinois
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.