Sr RN Case Manager Care for Me Program Float

UnitedHealth Group Inc.•Las Vegas, NV

32d

About The Position

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. The Clinic Case Manager is responsible for fostering collaboration and a team approach for successfully supporting patients with high-risk health conditions to navigate the healthcare system. Promotes empowerment by facilitating the role of an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. Interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, case managers, social workers, and other educators. Acts as a clinic resource for the value-based population. Works in a less structured, self-directed environment and performs all delegated nursing duties within the scope of a RN license of the applicable state board of nursing. Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance and patient safety. Participation in Compliance and required training is a condition of employment. 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.

Requirements

Valid NV RN License
Current BLS Certification
3+ years of job-related experience in a healthcare environment
Knowledge of medical terminology
Proven skilled with MS Office software applications
Proven excellent communication, interpersonal, organization and customer service skills
Proven self-motivated, solid computer skills
Proven attention to detail
Proven ability to multi-task and work under pressure
Valid NV State Driver's license and access to reliable transportation

Nice To Haves

Bachelor's degree or higher in healthcare related field
2+ years of experience providing prior authorization or case management within health plan or integrated system

Responsibilities

Role embedded within the primary care clinic, working directly with patients, clinical and non-clinical teams
Participates in the identification of a focused clinic patient panel, as defined by the manager of Medical Management
Supports longitudinal care of the patient with chronic care conditions
Communicates with patients, responding to patient questions via patient portal and other modalities
Performs assessment of health conditions and implements care plan in collaboration with the member, caregiver(s), clinician(s), and/or other appropriate healthcare professionals to address need and goals
Pursues appropriate interventions to reduce risk of condition exacerbation, ER and hospitalization utilization
Performs medication reconciliation and collaborates with clinician partner as needed
Conducts Motivational Interviewing and Self-Management Goal setting
Provides patient education
Creates referrals to appropriate agencies and resources
Supports transition of care from Emergency Department or inpatient stay to outpatient setting
Performs assessment of transitional needs
Performs medication reconciliation
Establishes and reviews contingency plan
Provides patient education
Assists with post discharge needs such as home health care, prescriptions, transportation, Durable Medical Equipment (DME), appointments
Coordinates with providers to establish or update individualized plan of care
Creates referrals to appropriate internal and external resources
Achieves Quality Measures outcomes via reduction in HEDIS Gaps in Care
Performs accurate and timely documentation in the electronic medical record
Performs triage and clinical tasks within their scope of practice
Participates in daily huddles and monthly clinic meetings, as required
Prepares accurate and timely reports, as required
Maintains continued competence in nursing practice and knowledge of current evidence-based practices
Performs ongoing updates of the care plan to evaluate effectiveness, and to document interventions and goal achievement
Maintains a working knowledge of community resources
Serves as facilitator and resource for other members of the Medical Group clinical team
Attends departmental meetings and provides constructive recommendations for process improvement
Performs other duties as assigned