The more health care changes, the more certain values count. Like quality, patient-centric care, compassion and a dedication to going the extra mile. As a Field-Based RN Case Manager, you'll wear many hats and work in a variety of environments. But wherever you happen to find yourself, you'll gain a profound sense of satisfaction knowing you're helping to create a more efficient and effective health care system for everyone. If you are located in Eastern Pennsylvania, you will have the flexibility to telecommute* as you take on some tough challenges. **Primary Responsibilities:** + Provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation. No direct patient care + Assist members in overall wellness and health prevention + May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols + May interact with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed + Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice + Partner with the practice's administrative and clinical staff while managing patient appointments and data between visits + Create and maintain a professional and supportive relationship with the patient, provider and office staff + Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services + Assists the member to access community, Medicare, family and other third-party resources as appropriate + Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member + Provides education to members regarding health care needs and available services + Utilize critical thinking skills to assist members in removing barriers to closing Star gaps + Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care + Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address + Documents all care coordination activities and interventions in the member's health plan clinical record + Maintains a focus on timely, high-quality customer service and the confidentiality of all sensitive information **Required Qualifications:** + Current, unrestricted RN license + Access to reliable transportation with a valid driver's license + 3+ years clinical experience in a hospital, acute care, home health/hospice, direct care or case management + Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications + Willing to travel up to 75% in Eastern Pennsylvania with quarterly visits to Pittsburgh **Preferred Qualifications:** + Case management experience including Certification in Case Management + Home care/field based case management + Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs + Experience with HEDIS and Medicare Stars quality management + Bilingual skills + Experience in Home & Community based or Long Term Care services delivery Make a difference in countless lives, starting with your own. Join us and start doing **your life's best work.(sm)** **Careers with UnitedHealthcare** . Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do **your life's best work.(sm)** Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. _Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._ Job Keywords: Registered Nurse, RN, case manager, case management, managed care, field-based, healthcare, health care
Associated topics: asn, bsn, cardiothoracic, care, care unit, domiciliary, intensive, maternal, nurse rn, registed
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.
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