RN Case Manager

View the Realistic Job Preview to learn more aspects of this job. Click here: AMC_Telephonic_Case_Manager.pdf

Responsibilities for Case Managers include:
-Making outbound calls to assess members' current health status
-Identifying gaps or barriers in treatment plans
-Providing patient education to assist with self management
-Interacting with Medical Directors on challenging cases
-Coordinating care for members
-Making referrals to outside sources
-Coordinating services as needed (home health, DME, etc)
-Educating members on disease processes
-Encouraging members to make healthy lifestyle changes
-Documenting and tracking findings
-Utilizing Milliman criteria to determine if patients are in the correct hospital setting


What makes your clinical career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You can work with in an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.


?Collaborates with providers and members to coordinate care services for members that are being discharged or changing a level of care

? Strong clinical & motivational interviewing skills with ability to make a personal connection and to encourage positive member behavior.

?Ability to understand and manage the clinical, psychosocial and disabling aspects of chronic disease.

?Ability to assess, prioritizes, and address member?s needs through structured and focused interventions.

?Assists members to navigate the complexities of the health care system.

?Creative problem solving skills with ability to use community and network resources.

?Excellent time management skills.

?Computer literacy.

?Ability to summarize case history and present to peers for quality improvement review.

?Function independently and responsibly with minimal supervision.

?Works in a multidisciplinary team with emphasis on medical management of the member during a transition of care

?Develop knowledge of community resources and alternate funding arrangements available to members when services are not available under benefit program

?Reports incidents to internal department by identifying Quality Indicators and Sentinel Diagnoses as they occur

?Excellent verbal and written communication skills



Specific Education:

?Clinical Registered Nurse with current licensure required

?Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements

?3 years Clinical background, experience in behavioral health and complex, community case management is desired

?A minimum of 1 year case management experience required

?Bachelors degree in Science 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.

?Home care/field based case management experience preferred
Positions in this function include RN (with current licensure) and LPN/LVN roles that 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. Includes Health Coach, Health Educator, and Health Advocate roles that require an RN.
- Generally work is self-directed and not prescribed.

- Works with less structured, more complex issues.

- Serves as a resource to others.