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 RN Telephonic Medicare Case Manager - Greensboro, NC, 10am-7pm - Greensboro, North Carolina, United States

   
Job information
Posted by: UnitedHealth Group 
Hiring entity type: Insurance 
Work authorization: Existing work authorization required for United States
Position type: Direct Hire, Full-Time 
Compensation: ******
Benefits: See below
Relocation: Not specified 
Position functions: Nursing - Case Management
Nursing - Clinic RN
 
Travel: Unspecified 
Accept candidates: from anywhere 
Languages: English - Fluent
 
Minimum education: See below 
Minimum years experience: See below 
Resumes accepted in: English
Cover letter: No cover letter requested
Job code: 523201 / Latpro-2497488 
Date posted: Jun-04-2013
State, Zip: North Carolina, 27499

Description

Primary Responsibilities:
  • Telephonically assesses and interprets customer needs and requirements 
  • Conduct telephonic screening/semiannual reassessments within designated timeframes for members (assessment areas include clinical, behavioral, social, environmental and financial) 
  • Prioritize care needs, set goals and develop a treatment plan (or plan of care) for high risk members with key focus on preventive care and health maintenance/promotion activities 
  • Provide education, information, direction, and support related to care goals of members and available community resources and supports 
  • Must exhibit strong problem solving skills; Identifies solutions to non-standard requests and problems 
  • Ensure appropriate utilization and consistent application of the member benefits (both Medicaid benefits and coordination with other existing payer sources), assist member to gain access to needed services, supplies, equipment 
  • Engage member, family, caregivers, PCP's, and healthcare providers to assure that a well-coordinated treatment plan (or plan of care) is established
  • Document assessments, care/service plans, interventions, and follow-up on care management activities in the electronic clinical record 
  • Maintain a focus on timely, quality customer service 
  • Facilitate problem resolution with cross-functional internal team, members, providers, and other agencies or entities as needed 
  • Work to facilitate member compliance and to ensure continuity of care
  • Solves moderately complex problems and/or conducts moderately complex analyses 
  • Translates nursing process and case management concepts into practice
OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.




Requirements

Required Qualifications:
  • Active, unrestricted RN licensure in state of North Carolina 
  • 3+ years of experience in any clinical setting (acute care preferred) 
  • Proficient level of experience with Microsoft Word and Excel, and the ability to navigate a Windows environment 
  • Must live within a commutable distance of Greensboro, NC office (50 min or 50 miles) 
  • Ability to perform in a fast paced, high demand environment 
  • Adapts well to frequent change in process
Additional Preferred Assets:
  • BSN 
  • Previous Case Management experience 
  • Certified Case Manager (CCM) 
  • Experience working with the Medicare population
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.

By providing 58 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.

At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
 
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth 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.

 

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