UnitedHealth Group-posted 6 months ago
$28 - $50/Yr
Full-time • Entry Level
Onsite • Atlantic City, NJ
Insurance Carriers and Related Activities

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The RN Case Manager will be the primary care manager for a panel of members with complex medical/behavioral needs. Care management activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. Expect to spend about 75% of your time in the field visiting our members in their homes or in long-term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations. Do you live or are you willing to travel to any of the following counties? Atlantic and Cumberland Counties - NJ.

  • Perform initial and concurrent review of inpatient cases applying MCG criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
  • Discuss cases with facility healthcare professionals to obtain plans-of-care
  • Collaborate with UnitedHealthcare Medical Directors on performing utilization management
  • Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
  • Consult with the Medical Director as needed for complex cases and make appropriate referrals to sister segments
  • Provide clinical expertise when discussing case with internal and external Case Managers and Physicians
  • Identify delays in care or services and manage with MD
  • Follow all Standard Operating Procedures in end-to-end management of cases
  • Obtain clinical information to assess and expedite alternate levels of care
  • Facilitate timely and appropriate care and effective discharge planning
  • Participate in team meetings, education discussions and related activities
  • Maintain compliance with Federal, State and accreditation organizations
  • Identify opportunities for improved communication or processes
  • Participate in telephonic and in-person staff meetings
  • Plan for MCG Certification
  • Current, unrestricted RN license in New Jersey
  • 3+ years of total experience, including recent clinical experience in an inpatient/acute setting
  • Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
  • Experience performing discharge planning
  • Solid computer skills
  • Driver's license and access to reliable transportation, ability to travel up to 75% within assigned territory to meet with members and provider
  • Certification in Case Management or willingness to obtain
  • 2+ years of case management experience
  • Experience in utilization review and/or utilization management
  • Experience with MCG Guidelines or InterQual
  • Ability to work independently
  • Demonstrated effective verbal and written communication skills
  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase
  • 401k contribution
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