UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description
AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
As a Case Manager, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating. This may include case management, disease management, coordination of care and medical management consulting. You will also be responsible for providing health education, coaching and treatment decision support for members. Case Managers work in a variety of settings: in the community providing proactive care coordination to individuals and support to their families or in telephonic care management position.
Position functions include:
· Perform telephonic case management for all high risk member's
· Apply appropriate standard criteria Milliman/Interqual (PA only) to all clinical review received.
· Refers all cases that fall outside of standard criteria to the Medical Director for review, per HFS policy and procedure
· Document all clinical information in accordance with HFS policies and procedures in the member's electronic medical record.
· Adhere to the timeframes surrounding contractual terms as related to obtaining clinical information, communication with providers and internal disciplines
· Participate in scheduled rounds with interdisciplinary team
· Maintain open communication with interdisciplinary team
· Manage time efficiently while consistently meeting established productivity and quality standards
· Assist with projects and/or assignments designated by the Team Leader, Supervisor or Manager
· Must be flexible and team oriented.
· Other duties as Assigned
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Qualifications
Qualifications for this role include:
· Clinical Registered Nurse with current licensure in the state of Mississippi required.
· Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements
· 3+ years Obstetrical experience
· A minimum of 1 year case management experience required, CCM preferred
Ability to travel frequently within an assigned territory. Must posses reliable transportation.
Additional preferences include:
· Bachelors degree in Nursing or equivalent work experience required; Masters degree preferred
· Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
· Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
· Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
· Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
· Bilingual a plus.
Additional Assets Preferred:
- BSN
- 3+ years Clinical background, experience in behavioral health and complex, community case management is desired
- A Background in managed care
- Certified Case Manager (CCM)
- Experience /exposure with discharge planning
- Experience in utilization review, concurrent review and/or risk management
- Strong organizational skills and multitasking abilities will be keys to success
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
