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Nurse Care Manager - Telecommute in Phoenix, AZ Relevant Educational Qualifications Job

3 months ago Other categories Phoenix   132 views
Job Details

**This is a full time, Monday-Friday position. The RN must be able to do occasional field visits as needed in order to conduct critical face to face assessments. Territory Assignments are based on business needs. Applicants must be willing to carry a diverse clinical caseload and visit the member in their home, hospital, SNF and as needed in the PCP’s office.*** Current position need is to back up our NICU population but must also be flexible enough to carry a diverse care load.

If you are located in Phoenix, AZ, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Collaborates effectively with interdisciplinary team (IDT) to establish an individualized plan of care for members, goals including both short and long term
  • Works with the Utilization Management (UM) RNs, Social Worker (LMSWs) Care Managers and other internal and external providers to facilitate smooth care transitions
  • Serves as the primary clinical liaison with hospital, clinical and administrative staff for a smooth, seamless transition to the next level of care
  • Stratifies and / or validates member level of risk and communicates during transition process with IDT
  • Ensures standardized execution of workflow processes, such as increase in admissions, monthly audits, and referral to Social Workers (LMSWs) or internal programs
  • Performs member evaluations and onsite visits as needed in multiple settings, including but not limited to telephonic, member's homes, PCP/Specialists clinic, hospital, and skilled nursing facilities and provides feedback on planned interventions and outcomes of the plan of care
  • Coordinates and attends member visits with PCP and specialists as needed
  • Documents findings and develops individualized care plans in a concise/comprehensive manner compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • Advocates for members and families as needed to ensure the member’s needs and choices are fully represented and supported by the health care team:
  • Collaborates with providers to determine acuity of behavioral health concerns and refer members to appropriate community resources
  • Integrates a collaborative approach by attending interdisciplinary team meetings with nurses, physicians and pharmacy team regarding member care as needed
  • Utilizes professional knowledge and critical thinking skills to facilitate MD consultation on complex and/or complicated cases
  • Nurse Care Managers work with their supervisor to work their assigned care load in an efficient and effective manner utilizing time management skills to facilitate the total work process
  • Plans member transitions with internal medical management staff and external providers
  • Attends and participates in IDT meetings as directed
  • With the assistance of the UM team, guides physicians and hospital staff in their awareness of preferred contracts and providers as well as facilities
  • Enters timely and accurate data into designated care management applications as needed to communicate member needs and maintains audit scores of 95% or greater on a monthly basis as well as to be determined member satisfactory scores
  • Applies Nursing / Counseling / Social Work theory, knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function
  • Manages assigned care load in an efficient and effective manner
  • Performs all other related duties as assigned

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:

  • Current, unrestricted RN license in the state of AZ
  • 3+ years of clinical experience in a NICU, obstetrics and gynecology or pediatric population, acute care, home health and NICU setting
  • Experience using EMR and CM practice guidelines
  • Experience with Microsoft Office applications including Word
  • Knowledge of discharge planning alternatives options and interdisciplinary approaches
  • Able to handle sensitive issues with members and providers in a confidential manner according to HIPAA guidelines
  • Access to reliable transportation that will enable you to travel to client and / or member sites within a designated area. There will be 10% travel for meetings and trainings
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • CCM certification or obtained within 2 years of hire
  • 2+ years of care management experience
  • Experience working with individuals with multiple co-morbidities and complex medical conditions
  • Medical / Behavioral setting experience (i.e. hospital, managed care organization, or joint medical / behavioral out member practice)
  • Diabetes Disease care management and/or educator
  • Dual diagnosis experience with mental health and substance abuse
  • Experience working with low-income populations, aged, blind or disabled
  • Clinical training experience
  • Experience with Excel and PowerPoint
  • Bilingual (English / Spanish) language proficiency
  • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
  • Independent problem identification / resolution and decision-making skills
  • Able to prioritize, plan, and handle multiple tasks / demands simultaneously

UnitedHealth Group of Arizona are patient-centered groups working to support health plans with a top network of medical clinicians and hospitals that offer comprehensive care. We give patients the tools and resources to maintain their health and enjoy the activities that they love. We also offer transition programs that support patients leaving the hospital or skilled nursing facility and care Management programs that help patients with complex health problems get care in the comfort of their own homes.

UnitedHealth Group is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, UnitedHealth Group provides administrative and business support services to both owned and affiliated medical practices which are part of UnitedHealth Group Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. UnitedHealth Group support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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: Nurse Care Manager, RN, Registered Nurse, Clinical, NICU, OBGYNE, Pediatrics, Acute Care, Home Health, NICU, EMR, CM Practice, Phoenix, AZ, Arizona, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote

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Company Description
We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these select few, we offer the global reach, resources and can-do culture. We provide an environment where you’re empowered to be your best. We encourage you to take risks. And we offer a world of rewards and benefits for performance.