Field Case Manager RN - Cumberland and Surrounding Counties
Location: Crossville Tennessee
Description: UnitedHealth Group is hiring Field Case Manager RN - Cumberland and Surrounding Counties right now, this job will be placed in Tennessee. More details about this job opportunity please give attention to these descriptions. Apply for this position with your eyes wide open. Click here to view the Realistic Job Preview: UHC Community & State Field_Based_Case_! Manager.pdf
Territory: This position will cover Cumberland, Putnam and Morgan Counties
Conduct thorough and objective initial and ongoing face-to-face assessments of the member within specific mandated intervals to determine current status and needs, including physical, behavioral, functional, psychosocial and financial and health status expectation
Conduct telephonic, face-to-face and other additional assessments as needed to address member change in condition
Conduct telephonic or on-site grand rounds on members experiencing changes in condition
Identify members with the potential for high-risk complications and coordinate the appropriate supported self care in conjunction with the member and care coordination team
Act as an advocate for an individual's care needs by identifying and communicating opportunities for care interventions, including identifying and addressing functional deficits and gaps in care
Develops member speci! fic Plan of Care that will be utilized to obtain authorization! s for appropriate home and community based services, collaborating with staff to obtain authorization for those services and confirms that services are being provided and the member's needs are being met while transitioning from nursing facility to home
Management of critical transitions, supporting legacy discharge planning staff with member transition to the home setting
For members transitioning to a setting other than a community-based residential alternative setting, monitor the initiation and daily provision of services in accordance with the member's plan of care and take the immediate action to resolve gaps in care
Develop and implement targeted strategies to improve health, functional or quality of life outcomes, such as disease management or pharmacy management
Serve as a point of contact for coordination of all physical health, behavioral health and other home and community based services
Proactively educate members about the program
Monit! or hospitalizations and institutional facility admissions and re-admissions to identify issues and implement strategies to improve outcomes
Provide assistance in resolving concerns about service delivery or providers
Coordinate with member's primary care provider, specialists and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care;
Compare member's plan of care to establish pathways to determine variances and then intervene as indicated
Routinely assess and monitor member's status, needs and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to their plan of care, providers and/or services to promote better outcomes
Report quantifiable impact, quality of care and/or quality of life improvements as measured against the care coordination goals
Establish and maintain professional working relations with referral sources, community resources an! d care providers
Collaborates with the peers on member admissions, ! transitioning and/or discharge planning
Requirements:
· Undergraduate degree or equivalent experience.
· Current, unrestricted RN license in the State
· 2+ years of experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
· Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment
· Ability to drive up to 2 hours each way to members’ homes for visits
Additional Assets Preferred:
· A background in managed care
· Exposure to private duty nursing
· Case Management experience
· Certified Case Manager (CCM)
· Experience/exposure with discharge planning
· Experience in utilization review, concurrent review and/or risk management
· Strong organizational skills and multitasking abilities will be keys to success
UnitedHealthcare, part ! of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus: UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disable! d individuals at an affordable cost.Together, we’re removing the! barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Key words: icu, intensive care unit, er, emergency room, assess, ltc, long term care, home health, case management, care management, ccm, certified case manager, travel
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If you were eligible to this job, please email us your resume, with salary requirements and a resume to UnitedH! ealth Group.
If you interested on this job just click on the Apply button, you will be redirected to the official website
This job starts available on: Wed, 05 Jun 2013 02:54:01 GMT
Apply Field Case Manager RN - Cumberland and Surrounding Counties Here
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