Utilization Management LPN

UnitedHealth Group • Boston, MA

15h • $20 - $36 • Remote

About The Position

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. As an LPN MDS-HC Coordinator you will be a valued member of an Integrated and complex clinical management model that is member-centric and facilitates collaboration between health care teams. We focus on identifying and addressing physical, behavioral, psychosocial, and social determinants of health needs of our members, while also supporting member goals and choices through a person-centered, trauma-informed, and culturally attuned approach. In this telecommuting role, you’ll support field care managers by systematically reviewing and transcribing MDS-HC assessments into the State Portal. You will provide coaching and education, identify trends to determine additional educational opportunities to facilitate and ensure timely and accurate MDS-HC submissions in accordance with state contractual requirements. This position reports to the Manager of Health Services in the Health Services Department within the UnitedHealthCare Community Plan of Massachusetts. If you reside in the state of Massachusetts or a bordering state, you will enjoy the flexibility to telecommute as you take on some tough challenges.

Requirements

• Current and unrestricted independent licensure as an LPN for MA
• 2+ years of clinical experience
• Intermediate level of proficiency with MS Office, including Word, Excel, and Outlook
• Must reside in state of Massachusetts or a bordering state
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Nice To Haves

• Certified Care Manager (CCM) preferred but not required
• Prior experience with completing an MDS-HC
• 1+ years of community case management experience coordinating care for individuals with complex needs
• Ability to utilize an Electronic Medical Record or other electronic platform
• Bilingual

Responsibilities

• Review and transcribe the MDS-HC data into the State’s MDS-HC online portal
• Submit timely MDS-HC data in accordance with state contractual requirements including but not limited to obtaining signatures as needed
• If information is missing or if the data does not support the Request for Services, the MDS LPN Coordinator will provide education and coaching and request timely and accurate resolution
• Identify trends to facilitate inter-rater reliability
• Assist with implementing and maintaining reporting to support accurate and timely MDS-HC submissions including root cause analysis and action planning associated with denials, rating category changes and FEW status
• Communicate with all stakeholders the required information, issues and remediation efforts needed to ensure quality coordinated data is realized in a regularly scheduled communication vehicle
• Other duties as assigned

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree