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Job Details


UnitedHealth Group

RN Field Case Manager - Remote in LA

Healthcare

All

Full Time

On Site

No

Shreveport, Louisiana, United States

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 and start doing your life's best work.(sm)

As a Case Manager, you'll wear many hats, and work in a variety of environments. Sometimes, you'll interact with members leaving the hospital - possibly with new medications or diagnoses. Or perhaps you'll assist members with safe, effective transitions from care environments to where they live. You may also act as an intermediary between providers and members - serving in numerous roles, such as educator, evaluator, service coordinator, community resource researcher and more. The result? Fewer hospitalizations, ER visits and costly service gaps; and a less stressed, more effective health care system for us all. Want more flexibility, want more autonomy?

Telecommuting considered for this role.

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

Primary Responsibilities:

  • Provide a complete continuum of quality care through close communication with members via on-phone interaction
  • Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
  • Assist members with the transition from a care facility back to their home
  • Providing full Case Management services for disabled members approved for EPSDT PCS, PDN & PDHC including: (EPSDT PCS = Early Periodic Screening Diagnostic Treatment Personal Care Services/PDN = Private Duty Nursing/PDHC = Pediatric Day Health Care)
  • Assessing needs
  • Establishing a plan of care
  • Service coordination
  • Community resource utilization
  • Implementing the plan of care
  • Evaluating the plan of care for effectiveness
  • Serve as a resource to members and their families/caregivers
  • Serve as a resource for providers
  • Full management of prior authorization requests for EPSDT PCS, PDN & PDHC
  • Clinical Audits of weekly /monthly/quarterly reports for compliance and reporting responsibilities for specialty populations
  • Clinical Project Management
  • Any other duty assigned by the Manager, Director of Clinical Services, Medical Director, Compliance Officer


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 LA
  • 3+ years of hands-on clinical experience
  • Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications such as Microsoft Word and Excel
  • Reside in the state of LA
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Certification in Case Management
  • Experience in a Managed Care environment and preferably Medicaid Managed Care
  • Case Management experience
  • Outpatient Prior Authorization/Outpatient Utilization Management experience
  • Experience in Behavioral Health field
  • Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
  • Experience in Home & Community based or Long-Term Care services delivery
  • Knowledge of ICUE
  • Bilingual skills


To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

*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.