The Complex Care Manager, RN will be managing complex members and is responsible for facilitating, promoting and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients (High risk stratification).
Care Manager will manage the care of members in their homes or other community settings by completing telephonic and or face to face health risk assessments and coordinating patient care, focusing on disease management and keeping members healthy and independent. The care manager will provide clinical and medical management services, including care management, health assessments, interventions, and discharge planning. Work is generally self-directed and not prescribed; so, it will be important to function in a less structured work environment.
Primary Responsibilities:- Engaging members/families telephonically and/or face to face to coordinate services, community resources, and treatment needs
- Delivering a holistic approach to coordinated care based on the member's needs using a person centered philosophy
- Identifying early risk factors and conducting ongoing assessments and documenting in an electronic file
- Creating, reviewing and revising care plans and focusing on a holistic approach
- Functioning as an advocate for member
- Collaborating with the member's PCP to deliver and coordinate necessary services
- Building relationships with members and their families; assisting them with coordination of health choices
- Ensuring cases are documented in a timely manner
- Coordination with other state agencies, community resources and providers
- Act as the primary point of contact for Members and the Interdisciplinary Care Team (ICT)
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 licensure in the state of Virginia
- 2+ years of recent experience in case management, home care, long term care and/or experience in acute or rehab care setting
- 1+ years of experience directly working with individuals with complex medical or behavioral needs
- Basic level of proficiency in Microsoft Office suite applications (Word, Excel, Outlook/Email, Internet), including the ability to type and talk at the same time and toggle between multiple applications
- Willingness to travel (up to 25%) within a designated geographical region of Virginia for home/site visits
- Driver's license and access to reliable transportation and proof of automobile insurance for vehicle being used
- Broadband internet capability from home office
Preferred Qualifications:- CCM certification
- Experience with Medicare and/or Medicaid
- Experience with complex populations
- Managed care/case management experience
*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 hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
