RN Case Manager - HouseCalls - Remote - EST or CST - Compact license Required

UnitedHealth Group•Columbia, MD

20h•$60,200 - $107,400•Remote

About The Position

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 HouseCalls 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. We’re connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together. We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. The HouseCalls Clinical Support Team (HCCST) supports Advanced Practice Clinicians in the HouseCalls business by providing telephonic consultation to plan members post HouseCalls visit. This position is completely telephonic in a call center environment. Goals of the program include providing a one-time outreach to members for follow up post HouseCalls visit to provide education and clarification on any concerns raised during their HouseCalls visit. The main objective of this program is to ensure successful transition of care from the HouseCalls Advanced Practice Clinician back to the members Primary Care Provider. This team includes nurse care managers and social workers. The Nurse Care Manager (NCM) will report directly to the Manager/or Director of Clinical Operations of HCCST. The NCM interacts via telephonic consult with members and providers to assist with education and clarification on any concerns raised during the HouseCalls visit and ensure the member has/or assist in obtaining an appointment with the provider to transition care. They work to ensure members receive quality customer service by answering questions, addressing concerns, providing education, providing resource information, and entering referrals. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Requirements

Undergraduate Degree
Current, unrestricted Compact RN (Registered Nurse) license in the state. (Additional licensure in assigned states must be obtained within 6 months of hire)
3+ years of clinical experience as a Registered Nurse in a hospital, acute care, home health/hospice, direct care, or case management position
Ability to work at home in a call center environment that requires: Being on the phone with members/providers for majority of shift
Being at your desk majority of shift excluding breaks and lunches
Have or the ability to obtain High speed Internet connection
Ability to manage telephonic systems for production purposes
Dedicated workspace that is HIPAA compliant for working with PHI
Proficient with Microsoft Word, Outlook, and Excel
Computer/typing proficiency to enter and retrieve data in electronic clinical records
Proven solid critical thinking skills
Proven ability to problem solve
Proven ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
Proven ability to perform positively and efficiently in production driven environment

Nice To Haves

Bachelor’s Degree
Case Management experience
Home care/field-based case management or telephonic case management experience
Medicaid, Medicare, or Managed Care experience
Bilingual skills

Responsibilities

Perform telephonic outreach to members identified by the Advance Practice Clinician for specific referral related issues
Ensure member has scheduled appointment with Primary Care Provider (PCP)/specialty provider; help scheduling appointment, if needed
Refer members to internal departments such as Social Work, or Clinical Help Desk when appropriate
Gather clinical information telephonically from patient/family
Assist patients/members with urgent needs requiring acute intervention that arise during the call
Identify triggers for hospitalization and barriers to meeting healthcare goals as they arise during the call
Complete required documentation in compliance with auditing standards and policies
Provide patient/family education on disease process and trigger management that arise during the call or are related to referral reasons
Assist with connections to appropriate community resources if needed
Understand and maintain confidentiality of legal and ethical issues
Maintains compliance with all HIPAA (Health Insurance Portability and Accountability Act) regulations
Enhance the experience of both internal and external customers by providing excellent customer service while maintaining production metrics
Serving as a clinical resource and consultant for other clinicians
Attend and participate in team huddles and staff meetings
Collaborating with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies
Provide cross-coverage support across the team and assist with special projects, as needed
Assume other duties as assigned and directed by the Supervisor or Manager of Clinical Call Center Operations