For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) The Maternal Child Health RN Case Manager will be responsible for managing a caseload of high risk maternity members as part of the Healthy First Steps (HFS) program. Responsibilities include outreaching to high risk pregnant members to assess, educate and coordinate care across the continuum of Medicaid benefits and services relevant to the population. The Case Manager will ensure that all required outreach, assessments, care planning, interventions and monitoring of member will be documented thoroughly and according to the health plan contract and regulatory requirements. Also, contact high risk members, providers and other community - based organizations to ensure members' needs are met to promote the best possible health outcome for mom and baby. Additionally, the Case Manager will work closely with other internal team members including behavioral health advocates, Community Health Workers, Clinical Practice Consultants to address member complex care needs, gaps in care, social and community resource needs and information and promote an interdisciplinary approach to effectively managing high risk members. May also represent the HFS program in various internal / external workgroups to streamline processes, share ideas and innovations, and improve the overall performance of the program. If you are located in the Manhattan, NY region, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:Outreach to high risk members to assess their needs, develop a plan of care, coordinate benefits and services and monitor progress and any other identified needs throughout the members' pregnancy and post - partum period Manage high risk complex members as part of an inter - disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), OB providers, behavioral health providers, etc. Ensure effective transitions of care occur and referrals to community - based services and resources are addressed Consult with care team to address specialty care services, community - based resources, and other member complex care needs Assist in identification of pregnant women and children including those with special health care needs and access / linkages to appropriate care Provide consult, training and technical assistance in the development of care plans with measurable goals and outcomes Promote preventive care and family planning services through various communication methods to members
Required Qualifications: Current and unrestricted Registered Nurse license for the state of New York 2+ years of maternal child health experience 2+ years of care coordination or utilization management experience Proficient computer skills in Microsoft Office to include Word and ExcelPreferred Qualifications:Bachelor's degree in Nursing Case management experience Experience working with Medicaid population Managed care experience 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 Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. 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. Job Keywords: RN, Nurse, Case Manager, Healthy First Steps, HFS, CCM, Maternity, Maternal Child, OB, High Risk OB, Medicaid , Public Health, Community Health, Home Care, Care Coordination, Home Health, Complex Case Management, Managed Care, Telecommute, Work from Home, WAH, Manhattan, New York, NY, UHG, UnitedHealth Group, UHC, UnitedHealthcare, Community and State, Public Sector
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.