Field based RN Case/Care Manager (506209)
Location: New Haven Connecticut
Description: UnitedHealth Group is at the momment seeking for Field based RN Case/Care Manager (506209) right now, this occupation will be placed in Connecticut. More complete informations about this occupation opportunity please give attention to these descriptions. With this innovative role comes the opportunity to contribute directly to the success and development of an exciting new! program. The On-site Case Manager works to coordinate the transitions between Skilled Nursing Facilities and long-term care facilities or patient homes or other community settings, ensuring that appropriate care is provided during all stages. You would also provide care management to enrollees admitted to post acute care facilities. If you're ready for a change of pace in an environment rich with team support, advancement and growth, we invite you to apply today.
The primary purpose of this position is to facilitate, promote, and coordinate post acute care within the most appropriate care setting through on site care management activities in post acute care facilities.
Field based Case Manager with 75% local travel required.
Responsibilities
Facilitate and expedite appropriate care for UnitedHealth Care Medicare and Commercial enrollees requiring post hospital placement and/or services and to assist in coordinating discharge needs.
Assist with discharge planning with transition to appropri! ate level of care; Inform hospital staff about resource availability at post acute care facilities being considered to facilitate appropriate continuity of care
Identify and promote clinically desirable alternatives such as home health services where appropriate.
Post acute care facility rounding to assess members to determine appropriate level of care utilizing Milliman criteria and/or Medicare guidelines.
Communicate with enrollees/caregivers/families to discuss benefits, progress, goals of care, discharge plans, etc.
Coordinate post acute care with ongoing assessment of medical necessity and readiness for a lower level of care through on site visits and weekly reviews; Concurrent review of clinical documentation in the post - acute care facility to determine appropriate level of care; Issue required Medicare coverage letters as appropriate.
Consult with the United Healthcare Clinical Services medical director when admission to! post acute care facility are not appropriate and in instances when members no longer meet criteria for continued stay; attend weekly medical director conference calls.
Participate in care conferences, family meetings, and discharge planning as appropriate
Refer to community based care coordinators as appropriate i.e. DME, home health, hospice, disease management, etc.
Document required clinical information within the appropriate computer system notification.
Serve as a liaison with facility staff, attending physician, therapists, consultants, and nursing staff.
Coordinates referral to internal post discharge clinical programs as appropriate
Identify potential quality of care concerns, delays of service and/or barriers to discharge
UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals a! nd groups; all part of something greater, but each with a specialized f! ocus:
UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.
UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.
UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.
Together, we’re removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity,! Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.
Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.
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Requirements
Current and unrestricted RN license in state of job posting
5+ years of hands-on direct patient care experience
Ability to travel in the local market - reliable and insured transportation
Computer proficiency (Word, Excel, Internet, Outlook)
Effective and proven written and oral communication and relationship and time management skills
Preferred Qualifications:
Case management background - preferred if there is no nursing home experience
Medicaid and/or Medicare experience is a plus
Managed care background
Certified Case Manager (CCM)
Discharge planning experience
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Milliman knowledge
Provide coverage for other markets as ! needed
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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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to UnitedHealth Group.
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This occupation starts available on: Tue, 02 Apr 2013 16:37:31 GMT