RN High Risk Case Manager - Remote in AZ Pima/Pinal Counties

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.

Positions in this function require various nurse licensure and certification based on role and grade level. 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, duties may include disease management activities and assist to impact HEIDIS results.

The High Risk Nurse Case Manager would be responsible for managing competing priorities which could range from securing, coordinating and authorizing skilled nursing services timely, review hospice or nursing progress notes routinely and provide direction as to ongoing need for continued services.

The position focuses on improving care coordination between the member, their physicians and caregivers. The purpose of this special approach to case management is to help reduce health care costs by coordinating, authorizing and monitoring skilled nursing services.

The High Risk Nurse Case Manager shall have a reliable vehicle, expect to spend up to 50% of their time in the field assessing members in their homes or hospitals.

The High Risk Nurse Case Manager need to be flexible, adaptable, organized, demonstrate problem-solving skills to assess for alternatives.

If you are located in Arizona, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities :

• Make outbound calls, receive inbound calls, coordinate initial orders for home health nursing, enter authorizations, seek / review clinical records every 60 days and documentation
• Interact with prescribers to offer recommendations to treatment plans, including cost effective alternatives, such as outpatient clinical supports, pharmacy supports or referrals to alternative care management programs
• Assist the assigned LTSS Case Manager with clinically challenging or complex membership which may include completion of field visits and / or telephonic interventions with the member to offer education to assist with self-management
• Works closely with its home bound network of providers (labs, eye professionals, nurses and imaging centers) to ensure quality delivery of services
• Provide additional coverage and support to High Risk Nurse Case Management Team which could include the completion of initial assessments for newly enrolled members eligible during a hospitalization and actively participate in the discharge process, coordinate or authorize services, supplies or initial placement as applicable
• Efficient, productive and thorough in their documentation of work activities
• Solid computer and software navigation skills are critical
• Patient-focused and adaptable to changes

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 Arizona RN license
• Background in managed care
• Able to type and have the ability to navigate a Windows based environment
• Have a reliable vehicle, ability to travel up to 50% of the time in the field assessing members in their homes or hospitals throughout the Pima / Pinal Counties
• Live in Arizona

Preferred Qualifications :

• 3+ years of experience in a hospital, acute care or direct care setting
• Case management experience
• Experience or exposure to discharge planning
• Experience in utilization review, concurrent review or risk management
• Knowledge and experience with Medicare / Medicaid programs
• 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.