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Growing together. This position will be the primary care manager for a panel of members with primary complex medical needs. The Care Management / coordination activities will focus on supporting member's medical, behavioral and socioeconomic needs to promote appropriate utilization of services and improved quality of care.
All case management/ coordination activities will be in alignment with evidence-based guidelines. This position will liaison with the members' provider community to help reduce fragmentation within the care ecosystem. The role will provide medically oriented clinical consults/guidance within the team and to other area within the health plan.
The Clinical Care Manager will approach their member work with an understanding of how inequities drive health disparities. They will promote health equity Working
Schedule is Monday through Friday between the hours of 8 am to 5 pm. This position is a field-based position with a home-based office. You will work from home when not in the field.
This position is primarily telephonic however if there is a need for a member visit, the visit will be scheduled closest to RN's zip code. These are the following counties Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, Union, Hardee, Highlands, Hillsborough, Manatee, Polk, Miami-Dade and Monroe Local travel up to 15% and mileage is reimbursed at current government rate.
Primary
Serve as primary care manager for members with primary complex medical needs Engage members through a variety of modalities (face and/or telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, community resources/partners and leverage expertise to implement care plan Monitor and update care plan, incorporating feedback from member to monitor compliance with interventions to achieve care plan goals Provide education and coaching to support: Member self-management of care needs in alignment with evidence-based guidelines Lifestyle changes to promote health, i.e. smoking cessation, weight management, exercise Assist member in development of personal wellness plan / health crisis plan Perform targeted activities and provide education to support HEDIS/STAR gap closure, including scheduling, reminding and verification of appointment to receive specific services Monitor compliance with medication regimen and make referrals to Pharmacist for medication review and recommendations Reassess and update care plan with change in condition or care needs Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Access and Coordinate Medicaid Benefits to support care needs Document all care management/coordination activity in clinical care management record 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
Current, unrestricted, independent licensure as a Registered Nurse 4+ years of relevant clinical work experience 3+ years of experience managing needs of complex populations (eg. Medicare, Medicaid) 1+ years of community case management experience coordinating care for individuals with complex needs Demonstrated knowledge of Medicare and Medicaid benefits Ability to travel 15% of time for role Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information and live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Master's degree in nursing or related clinical field Experience working with behavioral health issues that can be applied to help guide and support member's with behavioral health needs Experience working in team-based care Experience working in Managed Care Lived experience (self or family) in managing or overcoming a chronic health, behavioral health or substance use condition Bilingual in [Spanish] Soft
Possess a strong work ethic Ability to listen skillfully, collect relevant information, build rapport and respond to customers in a compassionate manner Ability to adapt to change in the workplace Ability to work independently and as a part of a team Ability to interact with internal and external customers in a corporate environment Must possess a positive and motivated attitude Willingness to adapt to multiple external environments and settings Physical Requirements and Work Environment Ability to transition from office to field locations multiple times a day Must possess transportation to visit clients in various locations Ability to travel varied distances and multiple terrains to visit assigned client locations Ability to carry equipment to and from field locations needed for face to face member visits (ex. laptop, stethoscope, blood pressure cuff, etc.) Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.
In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment.
We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve.
We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives. UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.