Houston, Texas
Glen Burnie, Maryland
Waterbury, Connecticut
Willow Creek, California
Posted: 13-Nov-24
Location: Cape May Court House, New Jersey
Salary: Open
Categories:
Internal Number: 144329182
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
As a Case Manager RN, this position may include some traveling to physician practices. Advocates review charts (paper and electronic - EMR), look for gaps in care, perform STARs assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Advocates primarily work at physician practices daily. This position does not entail any direct member care* nor does any case management occur. (*with the exception of participating in health fairs and/or health screenings where member contact could occur)
Standard Hours: Monday - Friday 8AM - 5PM; Subject to change as needed
You’ll enjoy the flexibility to telecommute* from anywhere within New Jersey as you take on some tough challenges.
Primary Responsibilities:
- Provides care coordination through physician practices for members to improve clinical quality and clinical documentation
- May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols
- May interact with members via telephone; Schedule appointments, Follow-up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed that relate to preventative health screenings or HEDIS gaps in care
- 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 member appointments and data between visits
- Create and maintain a professional and supportive relationship with the member, 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 appointments, screening or care related to preventative health screenings or HEDIS gaps in care
- Provides education to members regarding health care needs and available services related to preventative health screenings or HEDIS gaps in care
- Works to facilitate member compliance with their appointments, screenings, medications and/or action plans to complete open care opportunities/HEDIS gaps in care
- Identifies barriers for compliance in preventative health screenings or HEDIS gaps in care and communicates with members and providers to formulate action plan to address
- Documents member conversations and activities in Optum/UHC programs. No documentation in provider EMRs and/or member charts
- Maintains a focus on timely, high-quality customer service
- Maintains the confidentiality of all sensitive information
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
- 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.)
- More information can be downloaded at: http://uhg.hr/uhgbenefits
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Associate's Degree (or higher) OR 2+ years of nursing experience
- Current, unrestricted RN license in the state the staff member resides in as well as any state member outreach is performed
- 3+ years of clinical experience in a hospital, acute care, home health, direct care, or case management
- Intermediate level of proficiency in using EMR, Microsoft Office, Excel, PowerPoint, Outlook, Internet Explorer, or other web browsers
- Reliable transportation with a valid and unrestricted driver’s license, proof of insurance and the ability to travel to provider offices or other locations within service delivery area
- Ability to travel up to 25% to provider offices within service area – may require up to 2-hour radius for travel
Preferred Qualifications:
- Bachelor of Science in Nursing
- Case Management experience including Certification in Case Management
- Experience with HEDIS and EMR (electronic medical records)
- Experience with navigating and analyzing reports in Microsoft Excel
- Medicaid, Medicare, Managed Care experience
- Prior Physician Office experience
- Home care/field-based case management
- Experience in intensive care (ICU), emergency department (ER) nursing, or Home Health
- Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
- Call Center experience
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
New Jersey Residents Only: The salary range for New Jersey residents is $58,300 to $114,300 per year. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
#RPO #GREEN
