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.
This position will be the primary care manager for a panel of members with primary complex medical needs. The Care Management / coordination activities will focus on supporting member's medical, behavioral and socioeconomic needs to promote appropriate utilization of services and improved quality of care. All case management/ coordination activities will be in alignment with evidence-based guidelines. This position will liaison with the members' provider community to help reduce fragmentation within the care ecosystem. The role will provide medically oriented clinical consults/guidance within the team and to other area within the health plan. The Clinical Care Manager will approach their member work with an understanding of how inequities drive health disparities. They will promote health equity.
If you reside in Florida, you'll enjoy the flexibility to work remotely * as you take on some tough challenges.
Primary Responsibilities:
Serve as primary care manager for members with primary complex medical needs
Engage members through a variety of modalities (telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs
Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
Partner and collaborate with internal care team, providers, community resources/partners and leverage expertise to implement care plan
Monitor and update care plan, incorporating feedback from member to monitor compliance with interventions to achieve care plan goals
Provide education and coaching to support:
Member self-management of care needs in alignment with evidence-based guidelines
Lifestyle changes to promote health, i.e. smoking cessation, weight management, exercise
Assist member in development of personal wellness plan / health crisis plan
Perform targeted activities and provide education to support HEDIS/STAR gap closure, including scheduling, reminding and verification of appointment to receive specific services
Monitor compliance with medication regimen and make referrals to Pharmacist for medication review and recommendations
Reassess and update care plan with change in condition or care needs
Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
Access and Coordinate Medicaid Benefits to support care needs
Document all care management/coordination activity in clinical care management record
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, independent licensure as a Registered Nurse
4+ years of relevant clinical work experience
3+ years of experience managing needs of complex populations (e.g. Medicare, Medicaid)
1+ years of community case management experience coordinating care for individuals with complex needs
Demonstrated knowledge of Medicare and Medicaid benefits
Reside in the state of Florida
Preferred Qualifications:
Bachelor's degree or greater
Certification in Case Management (CCM)
Experience with vulnerable subpopulations include children and youth with special health care needs, adults with serious mental illness, children with serious emotional disturbances, members with substance use disorders, children in foster care or adoption assistance, and members with other complex or multiple chronic conditions
Case Management experience
Behavioral health experience
Bilingual experience - Spanish
Home care / field-based case management
Experience working in Managed Care
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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.
