RN Case Manager - HouseCalls - Remote - EST or CST - Compact license Required

100% Remote

As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come

The HouseCalls Clinical Support Team (HCCST) supports Advanced Practice Clinicians in the HouseCalls business by providing telephonic consultation to plan members post HouseCalls visit. This position is completely telephonic in a call center environment. Goals of the program include providing a one-time outreach to members for follow up post HouseCalls visit to provide education and clarification on any concerns raised during their HouseCalls visit. The main objective of this program is to ensure successful transition of care from the HouseCalls Advanced Practice Clinician back to the members Primary Care Provider.

This team includes nurse care managers and social workers. The Nurse Care Manager (NCM) will report directly to the Manager/or Director of Clinical Operations of HCCST. The NCM interacts via telephonic consult with members and providers to assist with education and clarification on any concerns raised during the HouseCalls visit and ensure the member has/or assist in obtaining an appointment with the provider to transition care. They work to ensure members receive quality customer service by answering questions, addressing concerns, providing education, providing resource information, and entering referrals.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Perform telephonic outreach to members identified by the Advance Practice Clinician for specific referral related issues
• Ensure member has scheduled appointment with Primary Care Provider (PCP)/specialty provider; help scheduling appointment, if needed
• Refer members to internal departments such as Social Work, or Clinical Help Desk when appropriate
• Gather clinical information telephonically from patient/family
• Assist patients/members with urgent needs requiring acute intervention that arise during the call
• Identify triggers for hospitalization and barriers to meeting healthcare goals as they arise during the call
• Complete required documentation in compliance with auditing standards and policies
• Provide patient/family education on disease process and trigger management that arise during the call or are related to referral reasons
• Assist with connections to appropriate community resources if needed
• Understand and maintain confidentiality of legal and ethical issues
• Maintains compliance with all HIPAA (Health Insurance Portability and Accountability Act) regulations
• Enhance the experience of both internal and external customers by providing excellent customer service while maintaining production metrics
• Serving as a clinical resource and consultant for other clinicians
• Attend and participate in team huddles and staff meetings
• Collaborating with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies
• Provide cross-coverage support across the team and assist with special projects, as needed
• Assume other duties as assigned and directed by the Supervisor or Manager of Clinical Call Center Operations

Required Qualifications

• Undergraduate Degree
• Current, unrestricted Compact RN (Registered Nurse) license in the state. (Additional licensure in assigned states must be obtained within 6 months of hire)
• 3+ years of clinical experience as a Registered Nurse in a hospital, acute care, home health/hospice, direct care, or case management position
• 1+ years remote call center experience
• Ability to work at home in a call center environment that requires:
• Being on the phone with members/providers for majority of shift
• Being at your desk majority of shift excluding breaks and lunches
• Have or the ability to obtain High speed Internet connection
• Ability to manage telephonic systems for production purposes
• Dedicated workspace that is HIPAA compliant for working with PHI
• Proficient with Microsoft Word, Outlook, and Excel
• Computer/typing proficiency to enter and retrieve data in electronic clinical records

Preferred Qualifications

• Bachelor's Degree
• Case Management experience
• Home care/field-based case management or telephonic case management experience
• Medicaid, Medicare, or Managed Care experience
• Bilingual skills

*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.