RN Case Manager, Private Duty Nursing - Remote in Kentucky

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

As a RN Case Manager, you will act in a clinical liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The RN works in a team-based structure and spends 25% of their time in the community engaging directly with members. You will work with medically complex patients who may be experiencing significant addiction and/or behavioral health conditions is important for this role.

This is high volume, customer centric environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone and in person. Solid computer and software navigation skills are critical.

If you reside in the state of Kentucky, you’ll enjoy the flexibility to work remotely - as you take on some tough challenges.

Primary Responsibilities

• Making outbound calls to assess members' current health status
• Manage a caseload of highly complex members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), Pediatric Extended Care Facilities, Private Duty Nursing Organizations, behavioral health providers, Primary Care Physicians, etc.
• Solves moderately complex problems and/or conducts moderately complex analyses
• Performing and coordinating management of Single case agreements
• Coordinating authorization of eligibility of Private Duty Nursing contracts for medically complex members
• Coordinating authorizations for eligible members with pediatric Extended Care facilities for medically complex pediatric members
• Consult with care team to address specialty care services, community-based resources, and other member complex care needs
• Working towards fulfilling medically complex member care needs
• Identifying gaps or barriers in treatment plans
• Providing member and care giver with education to assist with management of medically complex needs of member
• Interacting with Medical Directors, providers, internal and external partners on challenging cases
• Coordinating care for high risk, medically complex members
• Making referrals and connecting members to community resources
• Coordinating services as needed (home health, DME, etc.)
• Educating member and care giver on disease processes
• Performing periodic reviews of cases to determine continued eligibility of services
• Documenting and tracking findings
  
  

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 Kentucky
• 3+ years of experience in a hospital setting, acute care, direct care experience as an RN and / or experience as a telephonic Case Manager for an insurance company
• 2+ years of Pediatric/medically complex clinical nursing experience plus current / prior position as a Case Manager OR 3+ years of Pediatric/medically complex clinical nursing experience
• Proficiency with Microsoft Office Suite, with the ability to navigate a Windows environment
• Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, Internet research, use of online calendars and other software applications
• Access to reliable transportation and the ability to travel up to 25% of the time within the state for local and national training or as business needs demand.
• Ability to attend one week of onsite training in Louisville, KY office (travel accommodations provided)
  
  

Preferred Qualifications

• BSN or health care related degree
• Certified Case Manager (CCM)
• Experience in pediatrics or NICU
• Medicaid experience
• Case Management experience
• Experience working with chronic illness and complex care needs population
• Experience in utilization review, concurrent review and / or risk management
• Experience with HIV population
• Psychiatric or Behavioral Health experience
• A background in managed care
• Bilingual Spanish speaking
• Live in or within commutable driving distance to Louisville, KY
• Proven excellent communication and writing skills
• Proven problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Proven ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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: 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.