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 primary purpose of this position is to effect efficient transitions for Commonwealth Coordinated Care Plus members across the continuum, including transition of members from the nursing facility care to care in the community, and serve as a clinical resource for the Care Coordination Team. The scope of transition services includes assessing not only medical/health needs but also assessing the Member's social determinants of health (e.g., housing, transportation, social interactions, etc.). and the will development of an inclusive and realistic transition plan for the member and assist in addressing the components of a transition plan, i.e. assist with finding housing; setting up non-medical transportation; helping the individual integrate into the community through clubs, volunteering/work, faith organizations, etc. Primary Responsibilities:Participate in discharge planning for Members transitioning from acute institutional settings to lower levels of care, including Long Stay Hospitals, Nursing Facilities and the community Coordinate with the assigned care coordinator in discharge planning activities to ensure a safe transition that meets the Member's needs and preferences Coordinate with Utilization Management staff, as indicated regarding discharge planning Coordinate with Nursing Facility staff, the Member's assigned care coordinator, and the Member when it is identified that the Member wishes to transition from NF care to the community Provide support to care coordinators to maintain Members in the community in lieu of transitioning to institutional settings, as needed Utilize and partner with community resources (e.g. CILs, CSBs, AAAs, etc.) and work with staff to facilitate transitions when a member transitions to a lower or less restrictive level of care (e.g., a NF Member wishes to transition to the community, a member in inpatient hospital (medical or psychiatric) transfers to a NF or the community, a CCC Plus Waiver Member no longer meets NF criteria, etc.) Provide consistent follow up during the first year after discharge and shall make adjustments to the transition plan to assure acclimation and integration into the community as needed by the Member For Dual eligible members enrolled in a DSNP, the Regional Transition Coordinator shall also work with the DSNP care coordinator upon approval of the Member, to coordinate the above activities Review daily census and prioritizes daily work in accordance with Care Coordination policies Actively collaborate and communicate with physicians and providers to arrange appropriate follow up, discharge planning and / or alternative care and services for plan members Coordinate the authorization process for discharge planning needs in accordance with Plan policy and procedure Coordinate transition of members to other Level Care Coordinators when indicated Perform other delegated duties as assignedIf you are located in the state of Virginia, you will have the flexibility to telecommute* as you take on some tough challenges. This role requires 40-60% local travel and 10 - 15% statewide travel.
Required Qualifications:Current and unrestricted Registered Nurse License or Certified in the state of Virginia or hold a multi-state license recognized by Virginia Recent hospital acute care experience within Northern Virginia 3+ years of care coordination or behavioral health experience and / or work in a healthcare environment At least 1 year experience directly working with individuals with complex medical or behavioral needs Demonstrate the ability to communicate with members who have complex medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers Demonstrate ability to communicate and collaborate with multiple stakeholders on the implementation the transition plan Proficient computer skills in Microsoft Office to include Word, Outlook and the ability to type and talk at the same time and toggle between multiple screensPreferred Qualifications:Experience managing transitions between care setting, including transition from nursing facility care to care in the community Experience providing care coordination to persons receiving long-term care and/or home and community based services Experience working with Medicaid/Medicare population Long term care / geriatric experience Case management experience in a clinical setting (hospital, long term care, home health, hospice) or managed care Certified Case ManagerCareers 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, VAMLTSS, CCM, Discharge Planner, Acute Care, Hospital, Transition Coordinator, Medicaid Waver, Behavioral Health, Public Health, Community Health, Long Term Care, Rehab, Home Care, Care Coordination, Home Health, Complex Case Management, Managed Care, Bilingual, Arlington, Alexandria, Falls Church, Reston, Leesburg, Woodbridge, VA, Virginia, 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.