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. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)The Case Manager will be responsible for case management of members in Iowa for the Private Duty Nursing Program. Positions in this function include RN (with current licensure) 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, prior authorization, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for members. If you are located in Iowa, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:Making outbound calls to assess members' current health status Take incoming calls from members, caregivers and providers Identifying gaps or barriers in treatment plans Providing patient and caregiver 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 and caregivers on disease processes Encouraging members to make healthy lifestyle changes Documenting and tracking findings Completion of prior authorization process in a timely manner Flexibility to work during some weekends and holidays to complete prior authorization processes
Required Qualifications:Current, unrestricted RN license in the state of Iowa 3+ years of experience in a hospital setting, doctors office, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, Internet research, use of online calendars and other software applicationsPreferred Qualifications:Multi-state Nursing License Bachelor's Degree A background in managed care (MCO) Case Management experience Prior Authorization experience Certified Case Manager (CCM) Experience in utilization review, concurrent review and / or risk management Strong organizational skills and multitasking abilities will be keys to successCareers 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: private duty, nurse, RN, Iowa, Des Moines, IA
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.