The Care Services Clinical Operations team supports Advanced Practice Clinicians in the HouseCalls and Complex Care Management businesses by providing telephonic consultation to plan members and their healthcare providers in a call center environment, receiving and processing orders, providing member education on disease process, and coordinating care of members with other healthcare professionals. The Care Services team of call center clinicians includes dietitians, licensed practical nurses, nurse care managers, pharmacists and social workers. The Nurse Care Manager (NCM) will report directly to the Supervisor of Clinical Call Center Operations. The NCM interacts with members and providers to assist with clinical resources, telephonic support, patient specific care plans and other communications and supportive tasks. They work to ensure members receive quality customer service by answering questions, addressing concerns, providing education, providing resource information and entering referrals. Primary Responsibilities: Perform telephonic care management consultations with members, promoting high quality, evidence-based practice recommendations Ensure member has scheduled appointment with Primary Care Provider (PCP)/specialty provider; provide assistance scheduling appointment, if needed Refer members to internal departments such as Social Work or Dietitian, when appropriate Gather clinical information telephonically from patient/family Assess patients/members for urgent needs requiring acute intervention Identify triggers for hospitalization and barriers to meeting healthcare goals Completing care management assessments of members past medical history, disease states, and medications. Provide patient/family education on disease process and trigger management Collaborate with patient to develop self-management goal and monitors progress towards meeting the goal Assist with connections to appropriate community resources Utilize patient trigger in the development of patient-centric plan of care, which directs the focus of PVP visits and NCM calls Collaborate and coordinate with PVP, Caregivers, Care Manager Assistants (CMA) , health plan case managers/service coordinators and other healthcare professionals to meet the specific needs of the patient Participate in case conferences and interdisciplinary care team meetings as required Process orders from Primary Visiting Provider (PVP) Document all communications, consults and efforts in appropriate internal databases/systems according to established procedures Understand and maintain confidentiality of legal and ethical issues at all times Maintains compliance with all HIPAA regulations Meet requirements of Short Term Goal s (STG), Long Term Goals ( LTG) and SMART Goals (SMG) in patient-centric care plans using NCQA standards as required Enhance the experience of both internal and external customers by providing excellent customer service Serving as a clinical resource and consultant for other clinicians Attend and participate in weekly team huddles and staff meetings Working with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies Provide cross-coverage support across the team support and assist with special projects, as needed Assume other duties as assigned and directed by the Supervisor or Manager of Clinical Call Center Operations
Current, unrestricted RN license in the state. (Additional licensure in assigned states must be obtained within 6 months of hire)
3+ years of clinical experience in a hospital, acute care, home health/hospice, direct care, or case management position
Strong problem solving skills and the ability to perform positively and efficiently in production driven environment
Bilingual - Spanish
Case Management experience
Home care/field-based case management or telephonic case management experience
Medicaid, Medicare, or Managed Care experience
Computer/typing proficiency to enter and retrieve data in electronic clinical records
Proficient with Microsoft Word, Outlook, and Excel
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All 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: hospice, long term care, acute, RN, registered nurse, case manager, case management, long term care, home care, home health, UnitedHealth Group, Optum, telecommute, work from home, remote, Baltimore, Portland, Oregon, Maryland, MD, OR, Dallas, Texas, TX