Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

 

The Associate Care Manager facilitates a team approach to ensure cost-effective delivery of quality care and services based on medical conditions and social determinants. Collaborates with members, providers and other resources to evaluate, plan, facilitate and monitor options and services required to meet an individual's healthcare needs.  Promotes member's goals for self-management, facilitates effective health care navigation, reduces gaps in care, and provides support and community resources as needed. Ensures compliance to contractual and service standards as identified by relevant health insurance plans.  

 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have a valid CA nursing license.

 

Primary Responsibilities:

Conducts clinical evaluation of members per regulated timelines, determining who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and gaps in careConducts individual interview to obtain data for focused assessment and determines individual needs and prioritizes goalsConducts telephonic, clinic, facility, hospital or home visits as indicated for patient evaluation/engagementIdentifies barriers to care and seeks solutions with member and the care teamParticipates in the development and implementation of a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient's needs and goalsPerforms activities identified on the individual needs and prioritized goals to evaluate effectiveness, and to document interventions and goal achievementMaintains member case load for regular outreach and management and closes cases per procedure.Uses motivational interviewing to evaluate, educate, support, and motivate change during member contactsMaintains a working knowledge of community resourcesAchieves productivity and audit standards per department requirementsServes as facilitator and resource for other members of the medical group or clinical teamsAttends departmental meetings and provides constructive recommendations for process improvementAbility to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practicePerforms 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.

Required Qualifications:

Graduation from an accredited Licensed Vocational Nurse programActive compact license in CA2+ years of recent clinical experience working as an LVN/LPN1+ years of care management, disease management or discharge planning experienceAccess to dedicated workspace from home or an in-home office set upReside in a location that can receive a high-speed internet connection 

Skills:

All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patientsMust hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growthIntegrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfactionFollows written and oral instructions and completes routine tasks independentlyCompletes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signed AgreementsEnsures confidentiality of patient information following HIPAA guidelines and company policiesAttends training to meet requirements of the job position and as needed or mandated by company policies and regulationsHas regular and predictable attendance

 

Professional Competencies:

Working knowledge of health care delivery systemsWorking knowledge of PC applications including MS Office SuiteAbility to use written and oral communication skillsAbility to read and interpret dataSkill in writing clear, grammatically correct, easy to use instructional documentationAbility to identify learning needs, set goals and seek educational opportunitiesAbility to analyze problems and formulate appropriate plans, solutions, and courses of actionKnowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverballyAbility to work with frequent interruptionsAbility to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliatesAbility to maintain confidentiality of patient and all related entity business matters of the organization and its partnersAbility to manage detail and work with accuracy

 

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. 

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

 

The Associate Care Manager facilitates a team approach to ensure cost-effective delivery of quality care and services based on medical conditions and social determinants. Collaborates with members, providers and other resources to evaluate, plan, facilitate and monitor options and services required to meet an individual's healthcare needs.  Promotes member's goals for self-management, facilitates effective health care navigation, reduces gaps in care, and provides support and community resources as needed. Ensures compliance to contractual and service standards as identified by relevant health insurance plans.  

 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have a valid CA nursing license.

 

Primary Responsibilities:

Conducts clinical evaluation of members per regulated timelines, determining who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and gaps in careConducts individual interview to obtain data for focused assessment and determines individual needs and prioritizes goalsConducts telephonic, clinic, facility, hospital or home visits as indicated for patient evaluation/engagementIdentifies barriers to care and seeks solutions with member and the care teamParticipates in the development and implementation of a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient's needs and goalsPerforms activities identified on the individual needs and prioritized goals to evaluate effectiveness, and to document interventions and goal achievementMaintains member case load for regular outreach and management and closes cases per procedure.Uses motivational interviewing to evaluate, educate, support, and motivate change during member contactsMaintains a working knowledge of community resourcesAchieves productivity and audit standards per department requirementsServes as facilitator and resource for other members of the medical group or clinical teamsAttends departmental meetings and provides constructive recommendations for process improvementAbility to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practicePerforms 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.

Required Qualifications:

Graduation from an accredited Licensed Vocational Nurse programActive compact license in CA2+ years of recent clinical experience working as an LVN/LPN1+ years of care management, disease management or discharge planning experienceAccess to dedicated workspace from home or an in-home office set upReside in a location that can receive a high-speed internet connection 

Skills:

All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patientsMust hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growthIntegrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfactionFollows written and oral instructions and completes routine tasks independentlyCompletes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signed AgreementsEnsures confidentiality of patient information following HIPAA guidelines and company policiesAttends training to meet requirements of the job position and as needed or mandated by company policies and regulationsHas regular and predictable attendance

 

Professional Competencies:

Working knowledge of health care delivery systemsWorking knowledge of PC applications including MS Office SuiteAbility to use written and oral communication skillsAbility to read and interpret dataSkill in writing clear, grammatically correct, easy to use instructional documentationAbility to identify learning needs, set goals and seek educational opportunitiesAbility to analyze problems and formulate appropriate plans, solutions, and courses of actionKnowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverballyAbility to work with frequent interruptionsAbility to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliatesAbility to maintain confidentiality of patient and all related entity business matters of the organization and its partnersAbility to manage detail and work with accuracy

 

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. 

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

 

The Associate Care Manager facilitates a team approach to ensure cost-effective delivery of quality care and services based on medical conditions and social determinants. Collaborates with members, providers and other resources to evaluate, plan, facilitate and monitor options and services required to meet an individual's healthcare needs.  Promotes member's goals for self-management, facilitates effective health care navigation, reduces gaps in care, and provides support and community resources as needed. Ensures compliance to contractual and service standards as identified by relevant health insurance plans.  

 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have a valid CA nursing license.

 

Primary Responsibilities:

Conducts clinical evaluation of members per regulated timelines, determining who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and gaps in careConducts individual interview to obtain data for focused assessment and determines individual needs and prioritizes goalsConducts telephonic, clinic, facility, hospital or home visits as indicated for patient evaluation/engagementIdentifies barriers to care and seeks solutions with member and the care teamParticipates in the development and implementation of a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient's needs and goalsPerforms activities identified on the individual needs and prioritized goals to evaluate effectiveness, and to document interventions and goal achievementMaintains member case load for regular outreach and management and closes cases per procedure.Uses motivational interviewing to evaluate, educate, support, and motivate change during member contactsMaintains a working knowledge of community resourcesAchieves productivity and audit standards per department requirementsServes as facilitator and resource for other members of the medical group or clinical teamsAttends departmental meetings and provides constructive recommendations for process improvementAbility to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practicePerforms 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.

Required Qualifications:

Graduation from an accredited Licensed Vocational Nurse programActive compact license in CA2+ years of recent clinical experience working as an LVN/LPN1+ years of care management, disease management or discharge planning experienceAccess to dedicated workspace from home or an in-home office set upReside in a location that can receive a high-speed internet connection 

Skills:

All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous and respectful manner toward fellow employees, physicians and patientsMust hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growthIntegrates Lean principles, practices and tools to improve operational efficiency, reduce costs and increase customer satisfactionFollows written and oral instructions and completes routine tasks independentlyCompletes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signed AgreementsEnsures confidentiality of patient information following HIPAA guidelines and company policiesAttends training to meet requirements of the job position and as needed or mandated by company policies and regulationsHas regular and predictable attendance

 

Professional Competencies:

Working knowledge of health care delivery systemsWorking knowledge of PC applications including MS Office SuiteAbility to use written and oral communication skillsAbility to read and interpret dataSkill in writing clear, grammatically correct, easy to use instructional documentationAbility to identify learning needs, set goals and seek educational opportunitiesAbility to analyze problems and formulate appropriate plans, solutions, and courses of actionKnowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverballyAbility to work with frequent interruptionsAbility to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliatesAbility to maintain confidentiality of patient and all related entity business matters of the organization and its partnersAbility to manage detail and work with accuracy

 

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. 

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $36.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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$7,500 Sign On Bonus for External Candidates

 

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere.  As a team member of our Optum Care at Home team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home.  This life-changing work adds a layer of support to improve access to care. We're connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. 

 

Location: Field based position throughout Seattle, WA

Work Schedule: Monday through Friday 8:00 a.m. - 5:00 p.m. PST  Hours may vary based on business needs  

 

Primary Responsibilities:

Visit members in their homes to assess their current health statusIdentify gaps or barriers in treatment plansProvide patient education to assist with self-managementMake referrals to outside sourcesProvide a complete continuum of quality care through close communication with members via in-person in home or on-phone interactionSupport members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels

 

This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Strong computer and software navigation skills are critical. You should also be strongly patient-focused and adaptable to changes.

 

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.

Required Qualifications:

Current, unrestricted RN license in the state of WashingtonCertified in Basic Life Support, or ability to obtain by start date1+ years of clinical experienceExperience in home care/home visitsReside in or near Seattle, WADriver's license and access to reliable transportation

 

Preferred Qualifications:

BSNCertified Case Manager (CCM)Case management experienceExperience in discharge planningExperience in utilization review, concurrent review or risk management

Experience in a telephonic role

 

Experience working with MS Word, Excel and OutlookBackground in managed careBilingual in English/Spanish

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

Primary Responsibilities:

The Manager of Surgical Services provides leadership in the daily clinical operations of the Operating Room, Central Sterile Processing Department, Pre-Op and PACU departments, in accordance with established State rules and regulations, AAAHC and AORN standards for ambulatory surgical facilitiesDevelops and enforces compliance with ASC policies and proceduresThis position works closely with the providers, ASC Director, and ASC Leadership team

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.

Required Qualifications:

BSN or 5+years of comparable experience in an ASCActive current TX LicenseBCLS - AHA Healthcare ProviderCNOR certification or ability to obtain within a year of hire5+ years of clinical experience in the OR3+ years of experience in managementComputer skills; working knowledge of Word, PowerPointDriver's License and access to reliable transportation

 

Preferred Qualifications:

MSNSpecialty Certification - PreoperativeAmbulatory Surgery experienceAAAHC Preparation experience

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 to $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

 

The Care Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs.  The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of care management and discharge planning.  It is the purpose of the Care Manager - Registered Nurse to ensure that the psychosocial and educational needs of the members are met. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Care management services may be provided telephonically, in a provider office, or at the members' home.  

 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.  

 

Primary Responsibilities:

Develop a comprehensive care management plan that will address members' individual needs which include specific objectives, goals, and actionsPrioritizes member care needs upon initial interaction/assessment and address emerging issuesAssist members in the management of illness and treatment, monitor adherence, and proactively investigate and address problems that may contribute to non-adherence with the members and other members of the multidisciplinary teamAssesses reports, data, and other health plan information to identify potential members in need of care management interventionDecrease healthcare costs of members by working collaboratively to assist members in managing visits to primary care, to decrease ER Utilization, number of inpatient hospitalizations, readmits to hospital, admissions to skilled nursing facilities and home healthMonitor the effectiveness of the care management plan and short/long term goals and adjust per member needAssesses and prioritizes care referrals to assure program requirements for outreach and engagement are within expected time framesProvides member and family education, support, and encouragement, especially to enhance adherence to treatment regimen and follow up careDevelops communication protocols with physicians in the network, clinic, and community so that early notification and intervention by the care management team occurs for membersIndependently keeps current on areas of care management, quality management, utilization management, member education and preventive health guidelinesProvides recommendations in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelinesActs as liaison and members advocate with other care providers and programsParticipate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference)Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomesDevelop an effective support system within the family and community to manage emergency situations and to provide support and safety for the membersActs to prevent suicide and homicide in accordance with state licensure requirementsSupports collection of information and other statistical data relevant to care loads, productivity and health care trends within member populationPotential for RN oversight of LNP/LVN. Provide clinical supervision and direction to LPN/LVN staff in accordance with state scope of practice and organizational policiesMaintain overall accountability for member care outcomes delivered by LPN/LVNReview and validate care plans developed or supported by LPN/LVN staffProvide real-time guidance, coaching and clinical support to LPN/LVN staffPerforms additional duties as assigned

 

Professional Competencies:

Working knowledge of health care delivery systemsWorking knowledge of PC applications including MS Office Suite and other supportive technologyAbility to use written and oral communication skillsAbility to read and interpret dataSkill in writing clear, grammatically correct, easy to use instructional documentationAbility to identify learning needs, set goals and seek educational opportunitiesAbility to analyze problems and formulate appropriate plans, solutions, and courses of actionKnowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverballyAbility to work with frequent interruptionsAbility to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliatesAbility to maintain confidentiality of patient and all related entity business matters of the organization and its partnersAbility to manage detail and work with accuracyAbility to recognize and act appropriately in situations where patient care needs exceed scope of practiceSkill in working with a team and the ability to collaborate on projects with colleaguesSkill in working effectively under deadlines and changing prioritiesAbility to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practice

 

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

Required Qualifications:

Degree in Nursing from an accredited school of nursingUnrestricted RN licensureCA licenseCCM Certification within three years of employment

 

Preferred Qualifications:

Bachelor's Degree2+ years of clinical experience in a health care setting, care management for a health insurer

 

Skills:

All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous, and respectful manner toward fellow employees, physicians, and patientsMust hold relationships to a high standard- respectful approach to all people and interactions, listen to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growthIntegrates Lean principles, practices, and tools to improve operational efficiency, reduce costs and increase customer satisfactionFollows written and oral instructions, completes routine tasks independentlyCompletes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signs AgreementsEnsures confidentiality of patient information following HIPAA guidelines and company policiesAttends training to meet the requirements of the job position and as needed or mandated by company policies and regulationsHas regular and predictable attendance

 

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.    

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 

Read Less

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

 

The Care Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs.  The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of care management and discharge planning.  It is the purpose of the Care Manager - Registered Nurse to ensure that the psychosocial and educational needs of the members are met. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Care management services may be provided telephonically, in a provider office, or at the members' home.  

 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.  

 

Primary Responsibilities:

Develop a comprehensive care management plan that will address members' individual needs which include specific objectives, goals, and actionsPrioritizes member care needs upon initial interaction/assessment and address emerging issuesAssist members in the management of illness and treatment, monitor adherence, and proactively investigate and address problems that may contribute to non-adherence with the members and other members of the multidisciplinary teamAssesses reports, data, and other health plan information to identify potential members in need of care management interventionDecrease healthcare costs of members by working collaboratively to assist members in managing visits to primary care, to decrease ER Utilization, number of inpatient hospitalizations, readmits to hospital, admissions to skilled nursing facilities and home healthMonitor the effectiveness of the care management plan and short/long term goals and adjust per member needAssesses and prioritizes care referrals to assure program requirements for outreach and engagement are within expected time framesProvides member and family education, support, and encouragement, especially to enhance adherence to treatment regimen and follow up careDevelops communication protocols with physicians in the network, clinic, and community so that early notification and intervention by the care management team occurs for membersIndependently keeps current on areas of care management, quality management, utilization management, member education and preventive health guidelinesProvides recommendations in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelinesActs as liaison and members advocate with other care providers and programsParticipate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference)Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomesDevelop an effective support system within the family and community to manage emergency situations and to provide support and safety for the membersActs to prevent suicide and homicide in accordance with state licensure requirementsSupports collection of information and other statistical data relevant to care loads, productivity and health care trends within member populationPotential for RN oversight of LNP/LVN. Provide clinical supervision and direction to LPN/LVN staff in accordance with state scope of practice and organizational policiesMaintain overall accountability for member care outcomes delivered by LPN/LVNReview and validate care plans developed or supported by LPN/LVN staffProvide real-time guidance, coaching and clinical support to LPN/LVN staffPerforms additional duties as assigned

 

Professional Competencies:

Working knowledge of health care delivery systemsWorking knowledge of PC applications including MS Office Suite and other supportive technologyAbility to use written and oral communication skillsAbility to read and interpret dataSkill in writing clear, grammatically correct, easy to use instructional documentationAbility to identify learning needs, set goals and seek educational opportunitiesAbility to analyze problems and formulate appropriate plans, solutions, and courses of actionKnowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverballyAbility to work with frequent interruptionsAbility to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliatesAbility to maintain confidentiality of patient and all related entity business matters of the organization and its partnersAbility to manage detail and work with accuracyAbility to recognize and act appropriately in situations where patient care needs exceed scope of practiceSkill in working with a team and the ability to collaborate on projects with colleaguesSkill in working effectively under deadlines and changing prioritiesAbility to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practice

 

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

Required Qualifications:

Degree in Nursing from an accredited school of nursingUnrestricted RN licensureCA licenseCCM Certification within three years of employment

 

Preferred Qualifications:

Bachelor's Degree2+ years of clinical experience in a health care setting, care management for a health insurer

 

Skills:

All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous, and respectful manner toward fellow employees, physicians, and patientsMust hold relationships to a high standard- respectful approach to all people and interactions, listen to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growthIntegrates Lean principles, practices, and tools to improve operational efficiency, reduce costs and increase customer satisfactionFollows written and oral instructions, completes routine tasks independentlyCompletes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signs AgreementsEnsures confidentiality of patient information following HIPAA guidelines and company policiesAttends training to meet the requirements of the job position and as needed or mandated by company policies and regulationsHas regular and predictable attendance

 

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.    

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

WellMed, part of the Optum family of businesses, is seeking a Case Manager RN to join our team in Corpus Christi, TX. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The Case Manager II - Inpatient Services performs onsite review or telephonic clinical review of inpatient admissions in an acute hospital, rehabilitation facility, LTAC or skilled nursing facility. Actively implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate lower level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The case manager is responsible for coordinating the care from admission through discharge. The Case Manager participates in Patient Care Conferences to review clinical status, update/finalize transition discharge needs, and identify members at risk for readmission.  

Primary Responsibilities:

Independently collaborates effectively with Interdisciplinary care team (ICT) to establish an individualized transition plan for membersIndependently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria within our documentation systemPerforms expedited, standard, concurrent, and retrospective onsite or telephonic clinical reviews at in network and/or out of network facilities. The Case Manager documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines for all authorizations Interacts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit informationIdentifies member's level of risk by utilizing the Population Stratification tools and communicates during transition process the member's transition discharge plan with the ICTConducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of careManages assigned case load in an efficient and effective manner utilizing time management skills  Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activitiesIndependently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in department huddlesEnters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better on a monthly basisAdheres to organizational and departmental policies and proceduresTakes on-call assignment as directedThe Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicatedDecision-making is based on regulatory requirements, policy and procedures and current clinical guidelinesMaintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract termsRefers cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for complex case situationsMonitors for any quality concerns regarding member care and reports as per policy and procedurePerforms all other related duties as assigned

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

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.

Required Qualifications:

Bachelor's degree in Nursing and/or, Associate's degree in Nursing combined with 4+ years of experience above the required years of experienceCurrent, unrestricted RN license specific to the state of employmentCase Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment.  4+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions3+ years of managed care and/ or case management experienceKnowledge of utilization management, quality improvement, and discharge planningKnowledgeable in Microsoft Office applications including Outlook, Word, and ExcelProven ability to read, analyze and interpret information in medical records, and health plan documentsProven ability to problem solve and identify community resourcesProven planning, organizing, conflict resolution, negotiating and interpersonal skillsProven ability to utilize critical thinking skills, nursing judgement, and decision making skillsProven ability to prioritize, plan, and handle multiple tasks/demands simultaneouslyProven ability to be in a stationary position or move for prolonged periodsReliable transportation and Case Manager is responsible for maintaining an active driver's license

Preferred Qualifications:

Experience working with psychiatric and geriatric patient populationsBilingual (English/Spanish) language proficiency

Physical & Mental Requirements:  

Ability to lift up to 25 pounds  Ability to push or pull heavy objects using up to 10 pounds of force  Ability to sit for extended periods of time  Ability to stand for extended periods of time  Ability to use fine motor skills to operate office equipment and/or machinery  Ability to receive and comprehend instructions verbally and/or in writing  Ability to use logical reasoning for simple and complex problem solving  

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

 

The Care Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs.  The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of care management and discharge planning.  It is the purpose of the Care Manager - Registered Nurse to ensure that the psychosocial and educational needs of the members are met. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Care management services may be provided telephonically, in a provider office, or at the members' home.  

 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.  

 

Primary Responsibilities:

Develop a comprehensive care management plan that will address members' individual needs which include specific objectives, goals, and actionsPrioritizes member care needs upon initial interaction/assessment and address emerging issuesAssist members in the management of illness and treatment, monitor adherence, and proactively investigate and address problems that may contribute to non-adherence with the members and other members of the multidisciplinary teamAssesses reports, data, and other health plan information to identify potential members in need of care management interventionDecrease healthcare costs of members by working collaboratively to assist members in managing visits to primary care, to decrease ER Utilization, number of inpatient hospitalizations, readmits to hospital, admissions to skilled nursing facilities and home healthMonitor the effectiveness of the care management plan and short/long term goals and adjust per member needAssesses and prioritizes care referrals to assure program requirements for outreach and engagement are within expected time framesProvides member and family education, support, and encouragement, especially to enhance adherence to treatment regimen and follow up careDevelops communication protocols with physicians in the network, clinic, and community so that early notification and intervention by the care management team occurs for membersIndependently keeps current on areas of care management, quality management, utilization management, member education and preventive health guidelinesProvides recommendations in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelinesActs as liaison and members advocate with other care providers and programsParticipate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference)Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomesDevelop an effective support system within the family and community to manage emergency situations and to provide support and safety for the membersActs to prevent suicide and homicide in accordance with state licensure requirementsSupports collection of information and other statistical data relevant to care loads, productivity and health care trends within member populationPotential for RN oversight of LNP/LVN. Provide clinical supervision and direction to LPN/LVN staff in accordance with state scope of practice and organizational policiesMaintain overall accountability for member care outcomes delivered by LPN/LVNReview and validate care plans developed or supported by LPN/LVN staffProvide real-time guidance, coaching and clinical support to LPN/LVN staffPerforms additional duties as assigned

 

Professional Competencies:

Working knowledge of health care delivery systemsWorking knowledge of PC applications including MS Office Suite and other supportive technologyAbility to use written and oral communication skillsAbility to read and interpret dataSkill in writing clear, grammatically correct, easy to use instructional documentationAbility to identify learning needs, set goals and seek educational opportunitiesAbility to analyze problems and formulate appropriate plans, solutions, and courses of actionKnowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverballyAbility to work with frequent interruptionsAbility to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliatesAbility to maintain confidentiality of patient and all related entity business matters of the organization and its partnersAbility to manage detail and work with accuracyAbility to recognize and act appropriately in situations where patient care needs exceed scope of practiceSkill in working with a team and the ability to collaborate on projects with colleaguesSkill in working effectively under deadlines and changing prioritiesAbility to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practice

 

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

Required Qualifications:

Degree in Nursing from an accredited school of nursingUnrestricted RN licensureCA licenseCCM Certification within three years of employment

 

Preferred Qualifications:

Bachelor's Degree2+ years of clinical experience in a health care setting, care management for a health insurer

 

Skills:

All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous, and respectful manner toward fellow employees, physicians, and patientsMust hold relationships to a high standard- respectful approach to all people and interactions, listen to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growthIntegrates Lean principles, practices, and tools to improve operational efficiency, reduce costs and increase customer satisfactionFollows written and oral instructions, completes routine tasks independentlyCompletes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signs AgreementsEnsures confidentiality of patient information following HIPAA guidelines and company policiesAttends training to meet the requirements of the job position and as needed or mandated by company policies and regulationsHas regular and predictable attendance

 

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.    

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Read Less

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

 

We are currently offering a $10,000 sign on bonus for external candidates!

This position has accountability and oversight the NV Medical Management Command Center RN case Manager functions.   Medical Management includes observation level patients,  acute long-term level patients and the development of plans of care to for transitions of care at discharge.  This positions is responsible for the daily operations of medical management case managers in the assigned facilities.  Collection and oversight of documentation and safety of RN decisions at discharge.  Education and training is an integral part of this position to promote patient care. As a manager lead IDT meetings, participate in taskforces and ensures coverage at large volume hospitals and high risk patients. There is direct responsibility for the development and maintainence of metric performance for the assigned areas of the position.  

 

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members.  Ensure members receive quality medical care in the most appropriate setting.  Performs the following on a daily basis; 1) assurance of staffing higher volume hospitals and focusing the case managers on the standard work of command center; 2)  Productivity of case management teams; 3) Audit standard work 4) Produce daily, weekly and monthly operational metrics for the command center and 5) refocus team members on the tactics of the command center with report progress to the Sr. Medical Director

 

Primary Responsibilities:

Ensure the team provides appropriate education, training, support and resources to all staff so that all compliance and customer service standards are met including the appropriateness of decision making, timeliness and completeness of all requestsProvide support to the team to allow for growth and development and encourage the team to think "out of the box" for solutionsIdentify barriers so that staff can maintain high productivity and high levels of moraleEnsure coordination between other internal departments as well as external companies as appropriateDevelop work plans and educational plans to best manage the day-to-day functions of multidisciplinary departmentsIndependently manage work flows including orientation, standard work and report concerns to the directorCollaborates on decisions to promote teamworkCollaboration with Sr. Medical Director and V.P.Promote LEAN work cycles for performance enhancementProvides input to leadership to enhance process flows and efficiencies while addressing initiatives, goals, and missionOther duties as assigned in medical management
 

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.

Required Qualifications:

High School diploma and/or equivalentActive unrestricted Nevada RN licenseObtain CCM certification within 2+ years of employmentValid Nevada driver's license and maintain personal auto insurance coverage  1+ years of related professional experience in managed care environment1+ years related supervisory/management experience Solid knowledge of regulatory requirements, competent in case management business as well as clinical arenas Solid technology skills and excellent interpersonal skillsProven ability to negotiate and arbitrate without difficultyProven ability to supervise multiple levels of peopleCritical Thinking: Proven ability to integrate guidelines/tools to negotiate most effective plan of care

 

Preferred Qualification:

Bachelor's degree 

 

Working Conditions: 

Work completed in acute hospital and/or sub-acute and/or Inpatient Rehabilitation setting or office to promote command center management

Driving up to one hour per day.

 

Competencies for High Performers:   

Participation in departmental projects assigned by Director or Manager.Certification in Case Management (CCM) or equivalent Professional Certification (ACM).Metric measures of success: Observation rate discharge, LOS Observation Rate; Observation rate of engagement with patient's high risk patients, improved readmission rate of high risk patients (10 days) and engagement of PCP HFU rate, daily productivity 10-11 patients per day OBs note; Affordability measures 6 O'clock X matrix cost of care on engaged members.  Number of IDT completed within the week with Medical Director.
 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

 

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

 

The Care Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs.  The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of care management and discharge planning.  It is the purpose of the Care Manager - Registered Nurse to ensure that the psychosocial and educational needs of the members are met. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Care management services may be provided telephonically, in a provider office, or at the members' home.  

 

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.  

 

Primary Responsibilities:

Develop a comprehensive care management plan that will address members' individual needs which include specific objectives, goals, and actionsPrioritizes member care needs upon initial interaction/assessment and address emerging issuesAssist members in the management of illness and treatment, monitor adherence, and proactively investigate and address problems that may contribute to non-adherence with the members and other members of the multidisciplinary teamAssesses reports, data, and other health plan information to identify potential members in need of care management interventionDecrease healthcare costs of members by working collaboratively to assist members in managing visits to primary care, to decrease ER Utilization, number of inpatient hospitalizations, readmits to hospital, admissions to skilled nursing facilities and home healthMonitor the effectiveness of the care management plan and short/long term goals and adjust per member needAssesses and prioritizes care referrals to assure program requirements for outreach and engagement are within expected time framesProvides member and family education, support, and encouragement, especially to enhance adherence to treatment regimen and follow up careDevelops communication protocols with physicians in the network, clinic, and community so that early notification and intervention by the care management team occurs for membersIndependently keeps current on areas of care management, quality management, utilization management, member education and preventive health guidelinesProvides recommendations in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelinesActs as liaison and members advocate with other care providers and programsParticipate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference)Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomesDevelop an effective support system within the family and community to manage emergency situations and to provide support and safety for the membersActs to prevent suicide and homicide in accordance with state licensure requirementsSupports collection of information and other statistical data relevant to care loads, productivity and health care trends within member populationPotential for RN oversight of LNP/LVN. Provide clinical supervision and direction to LPN/LVN staff in accordance with state scope of practice and organizational policiesMaintain overall accountability for member care outcomes delivered by LPN/LVNReview and validate care plans developed or supported by LPN/LVN staffProvide real-time guidance, coaching and clinical support to LPN/LVN staffPerforms additional duties as assigned

 

Professional Competencies:

Working knowledge of health care delivery systemsWorking knowledge of PC applications including MS Office Suite and other supportive technologyAbility to use written and oral communication skillsAbility to read and interpret dataSkill in writing clear, grammatically correct, easy to use instructional documentationAbility to identify learning needs, set goals and seek educational opportunitiesAbility to analyze problems and formulate appropriate plans, solutions, and courses of actionKnowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverballyAbility to work with frequent interruptionsAbility to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliatesAbility to maintain confidentiality of patient and all related entity business matters of the organization and its partnersAbility to manage detail and work with accuracyAbility to recognize and act appropriately in situations where patient care needs exceed scope of practiceSkill in working with a team and the ability to collaborate on projects with colleaguesSkill in working effectively under deadlines and changing prioritiesAbility to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practice

 

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

Required Qualifications:

Degree in Nursing from an accredited school of nursingUnrestricted RN licensureCA licenseCCM Certification within three years of employment

 

Preferred Qualifications:

Bachelor's Degree2+ years of clinical experience in a health care setting, care management for a health insurer

 

Skills:

All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous, and respectful manner toward fellow employees, physicians, and patientsMust hold relationships to a high standard- respectful approach to all people and interactions, listen to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growthIntegrates Lean principles, practices, and tools to improve operational efficiency, reduce costs and increase customer satisfactionFollows written and oral instructions, completes routine tasks independentlyCompletes annual compliance training on HIPAA/Privacy/Confidentiality/Non-Discrimination/Harassment/Integrity Statement and signs AgreementsEnsures confidentiality of patient information following HIPAA guidelines and company policiesAttends training to meet the requirements of the job position and as needed or mandated by company policies and regulationsHas regular and predictable attendance

 

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

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.    

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 

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