Sr Case Manager in Clinic S Eastern

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The Clinic Case Manager is responsible for fostering collaboration and a team approach for successfully supporting patients with high-risk health conditions to navigate the healthcare system. Promotes empowerment by facilitating the role of an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. Interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, case managers, social workers, and other educators. Acts as a clinic resource for the value-based population. Works in a less structured, self-directed environment and performs all delegated nursing duties within the scope of a RN license of the applicable state board of nursing.

Ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance and patient safety. Participation in Compliance and required training is a condition of employment.

Primary Responsibilities :

Role embedded within the primary care clinic, working directly with patients, clinical and non-clinical teams

Participates in the identification of a focused clinic patient panel, as defined by the manager of Medical Management

Supports longitudinal care of the patient with chronic care conditions

Communicates with patients, responding to patient questions via patient portal and other modalities

Performs assessment of health conditions and implements care plan in collaboration with the member, caregiver(s), clinician(s), and / or other appropriate healthcare professionals to address need and goals

Pursues appropriate interventions to reduce risk of condition exacerbation, ER and hospitalization utilization

Performs medication reconciliation and collaborates with clinician partner as needed

Conducts Motivational Interviewing and Self-Management Goal setting

Provides patient education

Creates referrals to appropriate agencies and resources

Supports transition of care from Emergency Department or inpatient stay to outpatient setting

Performs assessment of transitional needs

Performs medication reconciliation

Establishes and reviews contingency plan

Provides patient education

Assists with post discharge needs such as home health care, prescriptions, transportation, Durable Medical Equipment (DME), appointments

Coordinates with providers to establish or update individualized plan of care

Creates referrals to appropriate internal and external resources

Achieves Quality Measures outcomes via reduction in HEDIS Gaps in Care

Performs accurate and timely documentation in the electronic medical record

Performs triage and clinical tasks within their scope of practice

Participates in daily huddles and monthly clinic meetings, as required

Prepares accurate and timely reports, as required

Maintains continued competence in nursing practice and knowledge of current evidence-based practices

Performs ongoing updates of the care plan to evaluate effectiveness, and to document interventions and goal achievement

Maintains a working knowledge of community resources

Serves as facilitator and resource for other members of the Medical Group clinical team

Attends departmental meetings and provides constructive recommendations for process improvement

Performs other duties as assigned

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 :

Valid NV RN License

Current BLS Certification

3+ years of job-related experience in a healthcare environment

Knowledge of medical terminology

Proven skilled with MS Office software applications

Proven excellent communication, interpersonal, organization and customer service skills

Proven self-motivated, solid computer skills

Proven attention to detail

Proven ability to multi-task and work under pressure

Valid NV State Driver’s license and access to reliable transportation

Preferred Qualifications :

Bachelor’s degree or higher in healthcare related field

2+ years of experience providing prior authorization or case management within health plan or integrated system

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 $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.