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The RN Clinical Case Manager is responsible for fostering collaboration and a team approach for successfully supporting patients with high risk health conditions to navigate the healthcare system. Promotes empowerment by facilitating the role of an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. Interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, case managers, social workers, and other educators. Acts as a clinic resource for the value-based population. Works in a less structured, self-directed environment and performs all nursing duties within the scope of a RN license of the applicable state board of nursing.
Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance and patient safety. Participation in Compliance and required training is a condition of employment.
If you are located in the Kansas City Metro area, you will have the flexibility to work from home and in the office in this hybrid role* as you take on some tough challenges.
Hybrid-field based role within Kansas City Metro area with 25% to 50% travel, working directly with both clinical and non-clinical staff
Participates in the identification of a focused clinic patient panel, as defined by the manager of Case/Disease management
Supports longitudinal care of the patient with chronic care conditions:
Communicates with patients, responding to patient questions via patient portal and other modalities
Performs assessment of health conditions and implements care plan in collaboration with the member, caregiver(s), clinician(s), and/or other appropriate healthcare professionals to address need and goals
Pursues appropriate interventions to reduce risk of condition exacerbation, ER and hospitalization utilization
Performs medication reconciliation and collaborates with clinician partner as needed
Conducts Motivational Interviewing and Self-Management Goal setting
Provides patient education
Creates referrals to appropriate agencies and resources
Supports transition of care from inpatient to outpatient setting:
Performs assessment of transitional needs
Performs medication reconciliation
Establishes and reviews contingency plan
Provides patient education
Assists with post discharge needs such as prescriptions, transportation, Durable Medical Equipment (DME), appointments
Coordinate with providers to establish or update individualized plan of care
Operates in the clinical role through support of standing orders or Care Paths
Creates referrals to appropriate internal and external resources
Achieves Quality Measures outcomes via reduction in HEDIS Gaps in Care
Performs accurate and timely documentation in the electronic medical record
May perform clinical tasks within their scope of practice
Participates in daily huddles and Patient Care Coordination (PCC) meetings, as required
Prepares accurate and timely reports, as required
Maintains continued competence in nursing practice and knowledge of current evidence-based practices
Performs ongoing updates of the care plan to evaluate effectiveness, and to document interventions and goal achievement
Maintains a working knowledge of community resources
Serves as facilitator and resource for other members of the Medical Group clinical team
Attends departmental meetings and provides constructive recommendations for process improvement
Performs other duties as assigned
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Associate’s degree in Nursing
Valid KS/MO RN license or valid multi-state compact license
Current BLS certification
3+ years of job-related experience in a healthcare environment
Must be 21 years or older and possess a valid KS/MO State driver’s license
Bachelor’s degree or higher in healthcare related field
2+ years of experience providing prior authorization or case management within health plan or integrated system
Proven knowledge of medical terminology
Experience with MS Office software applications
Demonstrated excellent communication, interpersonal, organization and customer service skills
Ability to be self-motivated and possess solid computer skills
Proven attention to detail
Ability to multi-task and work under pressure
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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