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The Senior Case Manager will identify, coordinate, or provide appropriate levels of care under the direct supervision of an RN or MD. Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for members.
Applies motivational interviewing in identifying impact on member engagement and setting goals
Member education, medication reconciliation and benefit management
Ensures follow through with the Care Navigation Team; timely appointments and referrals to programs, health plan and community
Facilitate patient/family and provider communications as indicated and advocate for patient/family with healthcare team as needed
Ensures coordinated services delivered and available programs are accessed
Communicate with stakeholders, appropriate health care related information to ensure timely coordination care and services for members currently receiving inpatient care
Utilizes approved clinical criteria to asses and determine appropriate level of care for members currently receiving inpatient care
Identified point of contact for managing transitions of care
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.
One year of post-high school education can be substituted/is equivalent to one year of experience.
Current, unrestricted NV RN license
3+ years of direct patient care nursing with a focus on discharge planning or case management
Proven knowledge of UM and plan benefit designs
Proven knowledge of Utilization review and MCG
Competent with MS Office and other practice management systems or possess the ability to continue to learn new things
Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
Solid clinical knowledge and capacity for continued learning
Proficient in critical thinking skills of RN Case manager
Proven ability to organize and prioritize tasks for self and patients
Proven solid verbal and written communication skills
Ability to perform case management activities
Nevada Residents Only: The salary range for Nevada residents is $67,800 to $133,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.