Positions in this family require a current, RN unrestricted nursing license in the applicable state, as indicated in the function description and/or job title.
Positions in this function require various nurse licensure and certification based on role and grade level. With RN current unrestricted licensure in applicable state. These roles 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.
General Job Profile- Generally work is self-directed and not prescribed
- Works with less structured, more complex issues
- Serves as a resource to others
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Assesses and interprets customer needs and requirements
- Identifies solutions to non-standard requests and problems
- Solves moderately complex problems and/or conducts moderately complex analyses
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Translates concepts into practice
- Provides explanations and information to others on difficult issues
- Coaches, provides feedback, and guides others
- Acts as a resource for others with less experience
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:- Undergraduate degree or equivalent experience
- Current unrestricted RN licensure in applicable state
Functional Competencies- CMT_Conduct Comprehensive, Holistic, or Focused Assessment of Consumer's Health Care C) Fully Proficient
- Scope of practice impact: The LPN: can contribute to the assessment of health status through gathering and recording of assessment data, observing and monitoring and reporting of changes in condition to the supervising RN. The RN is accountable for integration of the assessment for the plan
- Perform initial review of consumer health records and current health status (e.g., health risk scores) to identify health risk and determine next steps
- Receive information from consumers about specific symptoms and questions
- Conduct interviews to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
- Ask open ended questions, identify significant from insignificant responses, ask about other diagnoses, probe for additional information, and redirect as necessary
- Evaluate consumer data throughout the assessment process to identify inconsistencies and adherence to Evidence Based Guidelines - RN
- Identify and prioritize gaps to develop plan of care to empower consumers to meet identified goals- RN
- Determine consumer's willingness to engage in plan of care and readiness for change -RN
- Document assessment information and enter data in appropriate system
- CMT_Perform Planning Activities Based on Health Care Assessment C) Fully Proficient
- Scope of Practice impact: The LPN contributes to the development and modification of the plan of care. The RN identified the needs and goals, determines, modifies and prioritizes strategies to support the consumer is achieving the goals and expectations. -Consult with others (e.g., interdisciplinary team members) to review clinical assessment and obtain input as necessary
- CMT_Implement Interventions to Achieve Goals C) Fully Proficient
- Scope of Practice Implications: LPN contributes to the implementation process under the direction of the RN
- Refer consumers to appropriate internal and external resources as needed
- Engage consumer with meaningful interaction that will motivate commitment and increase level of activation
- Identify possible challenges to consumer success and provide continued support for goal attainment
- Contact member or provider to gather information on consumer progress toward plan goals
- Identify opportunities to update the care plan based on preferences, knowledge, success, progress
- Maintain consumer engagement by establishing rapport, demonstrating empathy, and building a trusting relationship
- Communicate rationale for interventions that are tailored to each situation to best teach and motivate consumers
- Partner with primary providers or multidisciplinary team to align or integrate goals to plan of care
- Determine consumer's level of health literacy and adjust approach or explanations to meet consumer needs
- Provide approved health information resources to consumers in a secure fashion (e.g., web links, e-mails)
- Document information using appropriate grammar, spelling, and punctuation, and ensure all critical information is included per documentation guidelines
- CMT_Evaluate Effectiveness of Interventions C) Fully Proficient
- Scope of practice implications: The LPN can contribute to the evaluation of the plan of care by gathering, observing, communicating consumers responses to interventions. Any modification in plan of care would be in collaboration with the RN
- Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals -Conduct follow up calls as indicated to reevaluate plan of care
- Determine whether consumer can demonstrate goal attainment
- Evaluate effectiveness of specific interventions to determine whether desired outcomes are achieved
- Revise plans of care or close cases based on consumer success toward goals
- Document goal attainment (e.g., proof points, completion of intervention to obtain goal, caller understanding of action plan) and enter data in appropriate systems
- CMT_Demonstrate Business and Industry Knowledge C) Fully Proficient
- Demonstrate knowledge of computer functionality and software applications (e.g., navigating systems, troubleshooting, electronic charting, accessing intranet and record management databases)
- Demonstrate knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, commercial) or regulatory bodies (e.g., HIPAA, URAC, ISO, Milliman, NCQA)
- Demonstrate understanding of relevant health care benefit plans (e.g., conservation of benefits)
- Demonstrate knowledge of applicable area of clinical specialization
- Utilize resources to enhance professional practice and development based on learning gaps or new information
- CMT_Drive Effective Clinical Decisions within a Business Environment C) Fully Proficient
- Demonstrate understanding of business implications of clinical decisions
- Identify and consider appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
- Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business results
- Identify and implement innovative approaches to the practice, in order to achieve or enhance quality outcomes and financial performance
- Use appropriate business metrics (e.g. member/FTE, length of stay, readmission rates, STAR ratings, member engagement rates) and applicable processes/tools (e.g. cost benefit analysis, return on investment, performance, staffing calculator) to optimize decisions and clinical outcomes
- Prioritize work based on business algorithms and established work processes, or in their absence, identify business priorities and build consensus to triage and deliver work (e.g. assessments, case/claim loads, previous hospitalizations, acuity, morbidity rates, quality of care follow up.)
- Understand and operate effectively/efficiently within legal/regulatory requirements (e.g., HIPAA, ARRA, SOX, CHAP, accreditation, state.)
Values Based CompetenciesEmployee
- 1. Integrity Value: Act Ethically
- Comply with Applicable Laws, Regulations and Policies
- Demonstrate Integrity
- 2. Compassion Value: Focus on Customers
- Identify and Exceed Customer Expectations
- Engage translators as appropriate
- Identify appropriate interventions and resources to meet gaps (e.g., psychosocial, transportation, long-term care) based on specific consumer needs
- Review and identify appropriate evidence based information for consumers
- Consult with consumer regarding possible areas for intervention and priorities
- Determine short and long term health goals
- Evaluate the consumer's understanding of health gaps and potential interventions
- Discuss benefits and risks of potential interventions with consumer to assess their willingness to change and support the plan of care
- Take member support and priorities into account to identify initial plan of care
- Document the plan of care in appropriate systems and enter data per specified format
- Improve the Customer Experience
- 3. Relationships Value: Act as a Team Player
- Collaborate with Others
- Demonstrate Diversity Awareness
- Learn and Develop
- 4. Relationships Value: Communicate Effectively
- Influence Others
- Listen Actively
- Speak and Write Clearly
- 5. Innovation Value: Support Change and Innovation
- Contribute Innovative Ideas
- Work Effectively in a Changing Environment
- 6. Performance Value: Make Fact-Based Decisions
- Apply Business Knowledge
- Use Sound Judgement
- 7. Performance Value: Deliver Quality Results
- Drive for Results
- Manage Time Effectively
- Produce High-Quality Work
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
