Medical Behavioral RN Case Manager - Remote

UnitedHealth Group•Everett, WA

23h•$60,200 - $107,400•Remote

About The Position

The Optumcare Medical Behavioral Integration Nurse Case Manager (MBI NCM) is a direct clinical liaison between OptumCare/Care Delivery organization customers and the clinical network. This position integrates a collaborative process which assesses plans, implements, coordinates, monitors and evaluates options and services to meet the member’s health needs, using education, communication and all available resources to promote quality, cost-effective outcomes. If you are located in Washington, you will have the flexibility to work in the field/remotely as you take on some tough challenges.

Requirements

Active and unrestricted licenses
RN with 2+ years of experience
Proficient computer skills and good working knowledge of Microsoft Word
Proven ability to maintain direct and open communication with all levels of the organization
Proven ability to handle sensitive issues with members and providers in a confidential manner according to HIPAA guidelines
Demonstrates initiative in achieving individual, team, and organizational goals and objectives
Demonstrated ability and flexibility to assume responsibilities and tasks in a constantly changing work environment
Ability to travel locally up to 75% of the time for patient home visits
Driver’s License and access to reliable transportation

Nice To Haves

2+ years of experience in a related field-based case management
Medical/Behavioral setting experience (i.e. hospital, managed care organization, or joint medical/behavioral outpatient practice)
Dual diagnosis experience with mental health and substance abuse
Experience working in an environment that required coordination of benefits and utilization of multiple groups and resources for patients
Experience working with low-income populations
Experience working with the aged, blind or disabled
Clinical training experience
Proven excellent customer service skills
Proven excellent interpersonal and problem-solving skills
Demonstrated solid team player and team building skills
Demonstrated solid oral and written communication skills, specifically telephone skills
Demonstrated ability to function independently and responsibly with minimal supervision

Responsibilities

Screens and identifies members with high-risk, long term chronic conditions who will benefit from care management services. Monitors utilization as needed. Referrals for cases may originate from various sources
Performs member evaluations and onsite visits as needed in multiple settings, including but not limited to: telephonic, member's homes, PCP/Specialists clinic, hospital, and skilled nursing facilities and provides feedback on planned interventions and outcomes of the plan of care
Performs comprehensive assessments, identifies and assists members with high-risk symptoms/diagnoses and/or members with multiple co-morbidities who will benefit from intervention and engaging in care management services, information is collected from the patient, caregiver(s), health care providers and other relevant parties as needed
Documents findings and develops individualized careplans in a concise/comprehensive manner compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
Utilizes advanced clinical skills to make effective decisions to meet the member’s health, behavioral health and psychosocial needs, providing coaching, patient education, communication, and all available resources to promote quality and cost-effective outcomes
Documents patient/family status, diagnosis, medications, treatment plan, goals, interventions, evaluation results, observations and progress in electronic medical record/proprietary database in a timely and accurate manner
Advocates for members and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
Integrates a collaborative approach by attending interdisciplinary team meetings with nurses, physicians and patient care coordinators regarding patient care as needed; Collaborates with providers to determine acuity of behavioral health concerns and refer members to appropriate community resources
Utilizes professional knowledge and critical thinking skills to facilitate MD consultation on complex and/or complicated cases
Applies Nursing/Counseling/Social Work theory, knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function
Manages assigned caseload in an efficient and effective manner