If you are located in El Paso, TX you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
- Conducting telephonic or face to face holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information from Member/family identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long-term services and supports
- Provides education and support to Member/LAR on options of Consumer Directed, or Service-Related delivery models as applicable
- Performs initial assessments and follow-up assessments and outreach calls within the time specified as part of contractual guidelines or per Member/family/provider request
- Identifies members for high-risk complications and coordinates care with the member and the health care team
- Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefit
- Assess, plan, and implement care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care
- Utilize both company and community-based resources to establish a safe and effective case management plan for members
- Collaborate with member, family, and healthcare providers to develop an individualized plan of care
- Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services
- Manage care plan throughout the continuum of care as a single point of contact
- Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
- Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team
- Utilize approved clinical criteria to assess and determine appropriate level of care for members
- Document all member assessments, care plan and referrals provided
- Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care
- Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan
- Monitor services being delivered to ensure timeliness, appropriateness, and satisfaction in meeting Member needs
- Reports medically complex cases to appropriate roles as necessary for review and problem solving
- Maintains status on face-to face- and telephonic visit requirements for assigned Members
Required Qualifications
- Graduate of an accredited school of nursing
- Current unrestricted RN license in Texas
- 3+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities as a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background
- 2+ years of experience working within the community health setting in a health care role
- 2+ years of experience working in a community health, clinical, hospital, acute care, direct care, or case management setting
- 2+ years of experience working with MS Word, Excel, and Outlook
- Demonstrated knowledge of specific case management processes, and person-centered care practice
- Demonstrated knowledge of all clinical resources available to patients both inpatient and outpatient
- Proven excellent verbal and written communication skills
- Proven analytical decision making and judgment skills
- Demonstrated ability to function as a clinical care team leader
- Proven data Entry and Word Processing Skills
- Ability to travel in assigned region to visit Medicaid members in their homes and / or other settings, including community centers, hospitals etc. This would be in the El Paso TX area.
- Bilingual English and Spanish
- Reliable transportation with valid driver's license with good driving record
Preferred Qualifications
- Bachelor's Degree in nursing
- CCM/RUG Certified
- 2+ years of experience working with Medicaid Waiver populations
- Experience with electronic charting
- Experience with arranging community resources
- Field-based work experience
- Behavioral Health Experience
- Experience in managing populations with complex medical or behavioral needs
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.