Registered Nurse Manager jobs at Highmark - 108 jobs
Care Manager RN - (Remote)
Highmark Health 4.5
Registered nurse manager job at Highmark
Company :Highmark Inc. :
This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.
ESSENTIAL RESPONSIBILITIES
Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager's professional discipline.
Function in accordance with applicable state, federal laws and regulatory compliance.
Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
Promote quality and efficiency in the delivery of care management services.
Respect the member's right to privacy, sharing only information relevant to the member's care and within the framework of applicable laws.
Practice within the scope of ethical principles.
Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
Employ collaborative interventions which focus, facilitate, and maximize the member's health care outcomes. Is familiar with the various care options and provider resources available to the member.
Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
Develop and sustain positive working relationships with internal and external customers.
Utilize outcomes data to improve ongoing care management services.
Other duties as assigned or requested
EDUCATION
Required
None
Substitutions
None
Preferred
Bachelor's Degree in Nursing
EXPERIENCE
Required
3 years of related, progressive clinical experience in the area of specialization
Experience in a clinical setting
Preferred
Experience in UM/CM/QA/Managed Care
LICENSES AND CERTIFICATIONS
Required
Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Additional specific state licensure(s) may be required depending on where clinical care is being provided.
Preferred
Certification in utilization management or a related field
SKILLS
Working knowledge of pertinent regulatory and compliance guidelines and medical policies
Ability to multi task and perform in a fast paced and often intense environment
Excellent written and verbal communication skills
Ability to analyze data, measure outcomes, and develop action plans
Be enthusiastic, innovative, and flexible
Be a team player who possesses strong analytical and organizational skills
Demonstrated ability to prioritize work demands and meet deadlines
Excellent computer and software knowledge and skills
Languages (Other than English)
None
Travel Requirement
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
Office-Based
Teaches/trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Does Not Apply
Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely, Occasionally
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$50,200.00
Pay Range Maximum:
$91,200.00
Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
$50.2k-91.2k yearly Auto-Apply 5d ago
Looking for a job?
Let Zippia find it for you.
Complex Case Manager RN - Oncology
Highmark Health 4.5
Registered nurse manager job at Highmark
This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members.
**ESSENTIAL RESPONSIBILITIES**
+ Maintain oversight over specified panel of members by performing ongoing assessment of members' health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.
+ For assigned case load, create care plans to address members' identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment.
+ Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved.
+ Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards.
+ Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization.
+ Other duties as assigned or requested.
**EDUCATION**
**Required**
+ High School Diploma/GED
**Substitutions**
+ None
**Preferred**
+ Bachelor's Degree in Nursing
**EXPERIENCE**
**Required**
+ 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
**Preferred**
+ Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
+ Experience working with the healthcare needs of diverse populations
+ Understanding of the importance of cultural competency in addressing targeted populations
**LICENSES AND CERTIFICATIONS**
**Required**
+ Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment.
**Preferred**
+ Certification in Case Management
**SKILLS**
+ Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion
+ Broad knowledge of disease processes
+ Understanding of healthcare costs and the broader healthcare service delivery system
+ Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data
+ Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization
+ Ability to work in a high performing team environment that requires flexibility
+ Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills
+ Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy
**LANGUAGE REQUIREMENT (Other than English)**
None
**TRAVEL REQUIREMENT**
0% - 25%
**PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS**
**Position Type**
Office-Based
Teaches/Trains others regularly
Rarely
Travels regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (Sales employees)
Does Not Apply
Physical Work Site Required
No
Lifting: up to 10 pounds
Rarely
Lifting: 10 to 25 pounds
Rarely
Lifting: 25 to 50 pounds
Rarely
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$57,700.00
**Pay Range Maximum:**
$107,800.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J273823
$57.7k-107.8k yearly 32d ago
RN Care Manager- La Crosse/Sparta
Humana 4.8
Remote
Become a part of our caring community and help us put health first Enjoy a rewarding career with a true work/life balance-no nights or weekends, giving you more time for what matters most. Humana is currently seeking RN Case Managers to join our teams in the La Crosse and Sparta offices, serving members in the Wisconsin Family Care (FC) program. In this vital role, you will collaborate with dedicated colleagues to ensure exceptional care coordination for our members, providing crucial support and education to help them thrive in their daily lives. Take the next step in your nursing career and make a meaningful difference with Humana.Key responsiblities:
Partner with a Care Coach (also referred to as a Case Manager), taking the lead on health-related needs, to collaborate on an ongoing basis regarding the member and their care plan.
Conduct regular health assessments for members and implement appropriate strategies and services to develop individualized care plans that support their continued health and safety.
Contribute to the creation, continuous evaluation, and coordination of the member's plan of care, including coordinating with outside providers to provide support with medication administration, assistance with home care, skilled nursing visits, and related services to ensure comprehensive care.
Contact and coordinate with acute and primary care providers.
Promote health and wellness through patient education on disease prevention, nutrition, exercise and lifestyle modifications.
Provide members with education and information about disease processes and related risks, supporting informed decision-making while respecting each individual's autonomy.
Daily documentation in member files within required DHS contract timeframes.
Participate in member monthly phone contacts and attend in person visits in members setting.
Traveling will be required and eligible for mileage reimbursement.
Use your skills to make an impact
Required Qualifications
Associate degree in nursing.
Must be a RegisteredNurse, licensed in the state of Wisconsin in good standing.
Demonstrated intermediate computer proficiency, including experience with Microsoft Office applications.
Preferred Qualifications
Bachelor degree in nursing.
One (1)+ years of experience with Family Care target group: frail elders and adults with intellectual, developmental, or physical disabilities.
Care Management experience
Additional Information
Workstyle: This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes.
Work Location: Either La Crosse WI or Sparta WI and surrounding area.
Travel: up to 40% throughout assigned area and surrounding areas
Typical Work Days/Hours: Monday through Friday, 8:00 am - 4:30 pm CST.
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
Driving
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits.
TB
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Modern Hire
As part of our hiring process for this opportunity, we will be using an interviewing technology called Modern Hire to enhance our hiring and decision-making ability. Modern Hire allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
SSN Alert
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
About Inclusa: Inclusa manages the provision of a person-centered and community-focused approach to long-term care services and support to Family Care members across the state of Wisconsin. As a values-based organization devoted to building vibrant and inclusive communities, Inclusa deploys a unique approach to managed care with a trademarked model of support named Commonunity which focuses on the belief in everyone, and from that belief, the common good for all is achieved. In 2022, Inclusa was acquired by Humana. This partnership will allow us to create a model of care that provides industry-leading support for members across the health care continuum.About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$71.1k-97.8k yearly Auto-Apply 33d ago
RN, Field Care Manager (Adults and Pediatrics)
Humana 4.8
Remote
Become a part of our caring community and help us put health first Humana Healthy Horizons in Virginia is looking for RN, Field Care Managers (Field Care ManagerNurse 2) who performs primarily face to face and telephonic assessments to adult and pediatric members. The RN, Field Care Manager (Field Care ManagerNurse 2) will evaluate member's needs to achieve and/or maintain optimal wellness. This position employs a variety of strategies, approaches, and techniques to manage a member's health issues and identifies and resolves barriers that hinder effective care. They ensure members are progressing towards desired outcomes by continuously monitoring care through use of assessment, data, conversations with member, and active care planning. The RN, Field Care Manager (Field Care Manager, Nurse 2) understands professional concepts, regulations, strategies, and operating standards. They make decisions regarding work approach/priorities and follows direction.
Responsible for managing a case load and completing assessments with members in their home or community-based setting, as well as telephonically.
Provides clinical support and guidance, particularly for members with medical complexity.
Develops and coordinates care plans ensuring that patients receive appropriate services to manage their health needs effectively.
Addresses barriers to health care and advocating for optimal member outcomes.
Reviews, assesses, and completes medical complexity attestations and clinical oversights.
Ensures members are receiving services in the least restrictive setting to achieve and/or maintain optimal well-being by assessing their care needs.
Develops and modifies Individual Care Plan and involve applicable members of the care team in care planning (Informal caregiver, coach, PCP, etc.).
Focuses on supporting members and/or caregivers utilizing an interdisciplinary approach in accessing social, housing, educational and other services, regardless of funding sources to meet their needs.
Collaborates with Community Health Workers (CHW), Housing Specialist and other internal and external agencies for HRSN needs.
Primary point of contact for the ICT and shall be responsible for coordinating with the member, ICT participants, and outside resources to ensure the member's needs are met.
Use your skills to make an impact
Required Qualifications
Must reside in the Commonwealth of Northern Virginia
Active RegisteredNurse (RN) license in the Commonwealth of Virginia without disciplinary action.
Two (2) years of prior experience in health care and/or case management.
One (1) year of experience working directly with individuals who meet the Cardinal Care Priority Population criteria
(adults, pediatrics populations at risk for chronic medical conditions and high social needs).
Strong advocate and respect for members at all levels of care.
Intermediate to advanced computer skills and experience with Microsoft Word, Excel, and Outlook.
Ability to use a variety of electronic information applications/software programs including electronic medical records.
Exceptional oral and written communication and interpersonal skills with the ability to build rapport with internal and external customers and stakeholders.
Ability to work with minimal supervision within the role and scope.
Ability to work a full-time schedule.
Preferred Qualifications
Prior experience with Medicare, Medicaid and dual eligible populations.
Bachelor's Degree Nursing (BSN).
Case Management Certification (CCM).
Experience with health promotion, coaching and wellness.
Knowledge of community health and social service agencies and additional community resources.
Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance.
See “Additional Information” section for more information.
Additional Information
Workstyle: Field - This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes.
Travel: 50 - 75% field interactions with members, and their families and providers. May need to attend onsite meetings occasionally in Humana Healthy Horizons office in Glen Allen, VA.
Workdays and Hours: Monday - Friday; 8:00am - 5:00pm Eastern Standard Time (EST).
Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government.
WAH Internet Statement
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
SSN Alert Statement
Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.
TB Screening
This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.
Driving Statement
This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and are expected to maintain personal vehicle liability insurance. Individual must carry vehicle insurance in accordance with their residing state minimum required limits, or $25,000 bodily injury per person/$25,000 bodily injury per event /$10,000 for property damage or whichever is higher.
Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$71.1k-97.8k yearly Auto-Apply 47d ago
Pre-Authorization Nurse Supervisor
Humana 4.8
Remote
Become a part of our caring community and help us put health first Ready to make a real impact? As our Pre-Authorization Nursing Supervisor, you'll lead the way in helping members get the care they need, when they need it. You'll oversee the PA staff who process service requests, make important decisions, and work closely with a great team to keep things running smoothly. If you're a nurse who loves collaborating, problem-solving, and making a difference, this is a fantastic opportunity to grow your career in a supportive environment. Come join us and help shape the future of care!
Essential Duties and Responsibilities:
Provide day to day support to the UM/PA staff
Perform monthly 1:1 check in with staff
Maintain staff training material and resources
Coordinate letter template updates (CMS and DHS requirements) with Compliance, NetDev, and IT to ensure the most current templates are available in TruCare and are used appropriately by PA Staff
Intermediate-level support during NCQA re-accreditation, including implementing updated process and policies necessary to meet NCQA standards.
Assist with leading bi-weekly department/ team meetings
Review PA requests for home health services, durable medical equipment, outpatient therapies, skilled nursing facility therapies, and all outpatient procedures pursuant to applicable Medicare and Medicaid criteria, iCare guidelines, and PA Department policies and procedures.
Review PA requests for inpatient medical stays, skilled nursing facility stays, long term acute hospital stays, inpatient rehabilitation facility stays per Humana/iCare's inpatient work processes and participates with facility discharge planners, Care Coordinators/Care Managers and the behavioral health personnel in coordinating the member's discharge needs.
Monitors outpatient and behavioral health activities daily for outcomes related to readmission, utilization, quality of care and provider performance in compliance with Humana/iCare policies.
Provide complete and accurate documentation specifying rational for approval, or for forwarding to the CMO/Medical Director for further review.
Create reduction/denial letters based on the CMO/Medical Director's review and applicable guidelines.
Maintain a thorough understanding of Medicare and Medicaid guidelines and stay abreast of updates and changes.
Work in collaboration with the PA staff to ensure timely and efficient completion of all workflows within the Department.
Assists with program and policy and procedure development for the PA Department.
Lead or participate in special projects.
Use your skills to make an impact
Required Qualifications
Licensed as a RegisteredNurse in the State of Wisconsin, including compact license.
Four (4) or more years of experience in clinical care.
Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook.
At least 3-years' experience with prior authorization/ utilization management.
Previous leadership experience.
Preferred Qualifications
Bachelor of Science in Nursing.
Knowledge of Milliman (MCG) or InterQual.
Knowledge of TruCare.
Managed Care experience.
Additional Information
Workstyle: Home. Home workstyle is defined as remote but will use Humana office space on an as needed basis for collaboration and other face-to-face needs.
Typical Work Days/Hours: Monday through Friday, 8:30am - 5:00 pm Central Standard Time (CST)
WAH Internet StatementTo ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested.
Satellite, cellular and microwave connection can be used only if approved by leadership.
Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.
HireVueAs part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.SSN AlertHumana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website.Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay Range
The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.
$78,400 - $107,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
Description of Benefits
Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
About us
Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
Equal Opportunity Employer
It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.
$78.4k-107.8k yearly Auto-Apply 6d ago
Care Manager RN - (Remote)
Highmark Health 4.5
Registered nurse manager job at Highmark
This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.
**ESSENTIAL RESPONSIBILITIES**
+ Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager's professional discipline.
+ Function in accordance with applicable state, federal laws and regulatory compliance.
+ Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies.
+ Promote quality and efficiency in the delivery of care management services.
+ Respect the member's right to privacy, sharing only information relevant to the member's care and within the framework of applicable laws.
+ Practice within the scope of ethical principles.
+ Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions.
+ Employ collaborative interventions which focus, facilitate, and maximize the member's health care outcomes. Is familiar with the various care options and provider resources available to the member.
+ Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships.
+ Develop and sustain positive working relationships with internal and external customers.
+ Utilize outcomes data to improve ongoing care management services.
+ Other duties as assigned or requested
**EDUCATION**
**Required**
+ None
**Substitutions**
+ None
**Preferred**
+ Bachelor's Degree in Nursing
**EXPERIENCE**
**Required**
+ 3 years of related, progressive clinical experience in the area of specialization
+ Experience in a clinical setting
**Preferred**
+ Experience in UM/CM/QA/Managed Care
**LICENSES AND CERTIFICATIONS**
**Required**
+ Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Additional specific state licensure(s) may be required depending on where clinical care is being provided.
**Preferred**
+ Certification in utilization management or a related field
**SKILLS**
+ Working knowledge of pertinent regulatory and compliance guidelines and medical policies
+ Ability to multi task and perform in a fast paced and often intense environment
+ Excellent written and verbal communication skills
+ Ability to analyze data, measure outcomes, and develop action plans
+ Be enthusiastic, innovative, and flexible
+ Be a team player who possesses strong analytical and organizational skills
+ Demonstrated ability to prioritize work demands and meet deadlines
+ Excellent computer and software knowledge and skills
**Languages (Other than English)**
None
**Travel Requirement**
0% - 25%
**PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS**
**Position Type**
Office-Based
Teaches/trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Does Not Apply
Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely, Occasionally
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement:_** _This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$50,200.00
**Pay Range Maximum:**
$91,200.00
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at *****************************
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J274568
$50.2k-91.2k yearly 4d ago
Behavioral Health, Maternity RN - Care Manager
Centene 4.5
Remote
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
****NOTE: This is a fully remote role with serving maternity and postnatal members with behavioral health conditions. Preference will be given to individuals who (1) possess an active Illinois registerednurse (RN) license, (2) have a combination of professional experience with high-risk maternity and behavioral health/substance use, as well as (3) virtual service coordination, case management, community advocacy. (4) Spanish language fluency is a plus.
Additional Details:
• Line of Business: Illinois Health Plan
• Department: MED-Medical Management (Case Management)
• Schedule: Monday through Friday, 8 AM to 5 PM Central
• Caseload: behavioral health maternity members. ****
Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.
Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
Identifies problems/barriers to care and provide appropriate care management interventions
Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned.
Complies with all policies and standards.
Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 - 4 years of related experience.
License/Certification:
RN - RegisteredNurse - State Licensure and/or Compact State Licensure required
For YouthCare Illinois plan only: Bachelor's Degree and IL RN licensure required. Must reside in IL
For Sunshine Health (FL) Only: Employees supporting Florida's Children's Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel required
Pay Range: $55,100.00 - $99,000.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$55.1k-99k yearly Auto-Apply 33d ago
RN Clinical Care Coordinator - Franklin County, OH
Unitedhealth Group 4.6
Columbus, OH jobs
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together**
The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.
This is a home-office based position with field responsibilities. You will spend approximately 50% to 75% of the time in the field within an assigned coverage area.
Candidates must be in Franklin County, OH and willing to commute to surrounding counties.
If you reside in Franklin County, OH or surrounding counties, you will have the flexibility to work remotely* as you take on some tough challenges.
**Primary Responsibilities:**
+ Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs
+ Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
+ Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
+ Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
+ Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
+ Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team
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 independent licensure as a RegisteredNurse in Ohio
+ 2+ years of clinical experience as an RN
+ 1+ years of experience with MS Office, including Word, Excel, and Outlook
+ Reliable transportation and the ability to travel up to 75% within Franklin County, OH and surrounding counties in OH to meet with members and providers
+ Reside in Franklin County, OH and surrounding counties
**Preferred Qualifications:**
+ BSN, Master's Degree or Higher in Clinical Field
+ CCM certification
+ 1+ years of community case management experience coordinating care for individuals with complex needs
+ Experience working in team-based care
+ Background in Managed Care
*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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ
_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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$28.3-50.5 hourly 60d ago
RN Clinical Care Coordinator - Franklin County, OH
Unitedhealth Group 4.6
Dublin, OH jobs
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start **Caring. Connecting. Growing together**
The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.
This is a home-office based position with field responsibilities. You will spend approximately 50% to 75% of the time in the field within an assigned coverage area.
Candidates must be in Franklin County, OH and willing to commute to surrounding counties.
If you reside in Franklin County, OH or surrounding counties, you will have the flexibility to work remotely* as you take on some tough challenges.
**Primary Responsibilities:**
+ Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs
+ Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
+ Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
+ Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
+ Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
+ Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team
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 independent licensure as a RegisteredNurse in Ohio
+ 2+ years of clinical experience as an RN
+ 1+ years of experience with MS Office, including Word, Excel, and Outlook
+ Reliable transportation and the ability to travel up to 75% within Franklin County, OH and surrounding counties in OH to meet with members and providers
+ Reside in Franklin County, OH and surrounding counties
**Preferred Qualifications:**
+ BSN, Master's Degree or Higher in Clinical Field
+ CCM certification
+ 1+ years of community case management experience coordinating care for individuals with complex needs
+ Experience working in team-based care
+ Background in Managed Care
*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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ
_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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$28.3-50.5 hourly 60d ago
RN Clinical Care Coordinator - Franklin County, OH
Unitedhealth Group Inc. 4.6
Dublin, OH jobs
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together
The RN Clinical Care Coordinator will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.
This is a home-office based position with field responsibilities. You will spend approximately 50% to 75% of the time in the field within an assigned coverage area.
Candidates must be in Franklin County, OH and willing to commute to surrounding counties.
If you reside in Franklin County, OH or surrounding counties, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
* Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs
* Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
* Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
* Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
* Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
* Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team
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 independent licensure as a RegisteredNurse in Ohio
* 2+ years of clinical experience as an RN
* 1+ years of experience with MS Office, including Word, Excel, and Outlook
* Reliable transportation and the ability to travel up to 75% within Franklin County, OH and surrounding counties in OH to meet with members and providers
* Reside in Franklin County, OH and surrounding counties
Preferred Qualifications:
* BSN, Master's Degree or Higher in Clinical Field
* CCM certification
* 1+ years of community case management experience coordinating care for individuals with complex needs
* Experience working in team-based care
* Background in Managed Care
* 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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ
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.
UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$28.3-50.5 hourly 26d ago
Senior Care Manager RN, Austin, TX
Centene 4.5
Remote
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
LTSS RN Case Manager - provide case management to ADULT members
LOCATION: Austin, TX and surrounding Central Texas area
Hybrid position - 4 days per week for member visits and work from home
Monday - Friday: 8 am - 5 pm (CST)
Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care.
Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome
Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs
Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / needs
Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable
Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
Reviews referrals information and intake assessments to develop appropriate care plans / service plans
Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines
Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Acts as liaison and member advocate between the member/family, physician, and facilities/agencies
Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living)
May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required
Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner
May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
Performs other duties as assigned
Complies with all policies and standards
Education/Experience: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 4-6 years of related experience
Bachelor's degree in Nursing preferred
License/Certification:
RN - RegisteredNurse - State Licensure and/or Compact State Licensure required or
NP - Nurse Practitioner - Current State's Nurse Licensure required
Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required
Pay Range: $36.21 - $65.09 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$36.2-65.1 hourly Auto-Apply 14d ago
Senior Care Manager RN
Centene 4.5
Remote
You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.
Position Purpose: Assesses, plans, and implements complex care management activities based on member activities to enable quality, cost-effective healthcare outcomes. Develops a personalized care plan / service plan for care members, addresses issues, and educates members and their families/care givers on services and benefit options available to receive appropriate high-quality care.
Develops and continuously assesses ongoing care plans / service plans and collaborates with providers to identify providers, specialist, and/or community resources needed to address member's unmet needs
Coordinates and manages as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
Monitors care plans / service plans and/or member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs
May identify problems/barriers for care management and appropriate care management interventions for escalated cases
Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
Reviews referrals information and intake assessments to develop appropriate care plans/service plans
May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed
Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner
May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness
Provides guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice
Engages and assists New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success
Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness
Other duties or responsibilities as assigned by people leader to meet business needs
Performs other duties as assigned
Complies with all policies and standards
Candidates for this role must be based in Michigan. The position supports members in Wayne and Macomb counties and requires approximately 75% travel to member homes, with the remaining time working remotely.
Education/Experience: Requires a Degree from an Accredited School or Nursing or a Bachelor's degree in Nursing and 4 - 6 years of related experience.
License/Certification:
RN - RegisteredNurse - State Licensure and/or Compact State Licensure required.
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
$73k-91k yearly est. Auto-Apply 54d ago
Field Nurse Case Manager
Unitedhealth Group 4.6
Columbus, OH jobs
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere.
As a team member of our Optum At Home product, together with an interdisciplinary care team we help patients navigate the health care system, and connect them to key support services. This preventive care can help patients stay well at home.
We're connecting care to create a seamless health journey for patients across care settings. Join us to start **Caring. Connecting. Growing together.**
RegisteredNurses in the Optum at Home program work with patients primarily in their home setting. They perform as part of a care team including a Nurse Practitioner, Behavioral Health Advocate, Care Navigator and other supporting team members. They deliver role appropriate patient care through in-home visits, telephonic outreach and consultations, and interdisciplinary team activities.
The Field Case Manager RN may perform care and counsel of the ill, injured, or infirm, in the promotion and maintenance of health with individuals, groups, or both throughout the life span. They help to manage health problems and coordinate health care for the Optum at Home patients in accordance with State and Federal rules and regulations and the nursing standards of care. This includes (but is not limited to) assessment of health status, development and implementation of plan of care, and ongoing evaluation of patient status and response to the plan of care. Clinical management is conducted in collaboration with other care team members.
**Primary Responsibilities:**
+ Reports to RN Manager
+ Assess the health status of members as within the scope of licensure and with the frequency established in the model of care
+ Establish goals to meet identified health care needs
+ Plan, implement and evaluate responses to the plan of care
+ Work collaboratively the multidisciplinary team to engage resources and strategies to address medical, functional, and social barriers to care
+ Works closely with mental health clinicians to help bridge the gap between mental and physical health
+ Consult with the patient's PCP, specialists, or other health care professionals as appropriate
+ Assess patient needs for community resources and make appropriate referrals for service
+ Facilitate the patient's transition within and between health care settings in collaboration with the primary care physician and other treating physicians
+ Completely and accurately document in patient's electronic medical record
+ Provide patients and family members with counseling and education regarding health maintenance, disease prevention, condition trajectory and need for follow up as appropriate during each patient visit
+ Verify and document patient and/or family understanding of condition, plan of care and follow up recommendations
+ Actively participate in organizational quality initiatives
+ Participate in collaborative multidisciplinary team meetings to optimize clinical integration, efficiency, and effectiveness of care delivery
+ Maintain credentials essential for practice, to include licensure, certification (if applicable) and CEUs
+ Demonstrate a commitment to the mission, core values and goals of UnitedHealthcare and its healthcare delivery including the ability to integrate values of compassion, integrity, performance, innovation and relationships in the care provided to our member
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.
Years of post-high school education can be substituted/is equivalent to years of experience.
**Required Qualifications:**
+ Current unrestricted licensure as RN in Ohio
+ 2+ years of relevant experience
+ Experience in assessing the medical needs of patients with complex behavioral, social and/or functional needs
+ Demonstrated ability to work with diverse care teams in a variety of settings including non-clinical settings (primarily patient homes)
+ Proven solid computer skills, including use of electronic medical records
+ Ability to travel 100% of the time for field-based work within 60 miles of residence
+ Valid driver's license
+ Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
**Preferred Qualification:**
+ Field based experience
+ Case management experience
+ Proven effective time management and communication skills
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 $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
_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._
$58.8k-105k yearly 10d ago
Registered Nurse Case Manager Hospice - PRN
Unitedhealth Group Inc. 4.6
Columbus, OH jobs
Explore opportunities with Caretenders Hospice, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.
As the RegisteredNurse Case Manager, you will assume full nursing responsibility for the delivery of the Plan of Care for each hospice patient. Continuously evaluating personal and professional performance and making necessary changes to increase productivity and quality of care delivered. You'll also develop the patient's Plan of care in collaboration with other professionals and implement treatment strategies based on scientific nursing theory that promotes physical, psychosocial, emotional, and spiritual well-being. Familiar with the concepts and needs of patients/families who are facing death and dying.
Primary Responsibilities:
* Makes the initial nursing evaluation in determining eligibility for hospice services during visit within forty-eight (48) hours of referral
* Identifies the patient's/family's physical, psychosocial, and environmental needs and re-assesses as needed, no less than every fifteen (15) days
* Initiates and coordinates the plan of care
* Documents problems, appropriate goals, interventions, and patient/family response to hospice care
* Collaborates with the patient/family, attending physician and other members of the IDG in providing patient and family care daily
* Instructs and supervises the patient/family in self-care techniques when appropriate
* Maintains accurate and relevant clinical notes regarding the patient's condition
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 and unrestricted RN licensure in the state of practice
* 1+ years of clinical experience
* Current CPR Certification
* Current driver's license, valid vehicle insurance, and access to a dependable vehicle, or public transportation
* Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client
Preferred Qualifications:
* Able to work independently
* Good communication, writing, and organizational skills
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 $58,800 to $105,000 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.
UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$58.8k-105k yearly 4d ago
RN Case Manager Hospice
Unitedhealth Group Inc. 4.6
Columbus, OH jobs
Explore opportunities with Caretenders Hospice, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.
As the RegisteredNurse Case Manager, you will assume full nursing responsibility for the delivery of the Plan of Care for each hospice patient. Continuously evaluating personal and professional performance and making necessary changes to increase productivity and quality of care delivered. You'll also develop the patient's Plan of care in collaboration with other professionals and implement treatment strategies based on scientific nursing theory that promotes physical, psychosocial, emotional, and spiritual well-being. Familiar with the concepts and needs of patients/families who are facing death and dying.
Primary Responsibilities:
* Makes the initial nursing evaluation in determining eligibility for hospice services during visit within forty-eight (48) hours of referral
* Identifies the patient's/family's physical, psychosocial, and environmental needs and re-assesses as needed, no less than every fifteen (15) days
* Initiates and coordinates the plan of care
* Documents problems, appropriate goals, interventions, and patient/family response to hospice care
* Collaborates with the patient/family, attending physician and other members of the IDG in providing patient and family care daily
* Instructs and supervises the patient/family in self-care techniques when appropriate
* Maintains accurate and relevant clinical notes regarding the patient's condition
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 and unrestricted RN licensure in the state of practice
* 1+ years of clinical experience
* Current CPR Certification
* Current driver's license, valid vehicle insurance, and access to a dependable vehicle, or public transportation
* Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client
Preferred Qualifications:
* Able to work independently
* Good communication, writing, and organizational skills
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 $58,800 to $105,000 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.
UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$58.8k-105k yearly 26d ago
Registered Nurse Case Manager Hospice - PRN
Unitedhealth Group 4.6
Columbus, OH jobs
Explore opportunities with Caretenders Hospice, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.**
As the RegisteredNurse Case Manager, you will assume full nursing responsibility for the delivery of the Plan of Care for each hospice patient. Continuously evaluating personal and professional performance and making necessary changes to increase productivity and quality of care delivered. You'll also develop the patient's Plan of care in collaboration with other professionals and implement treatment strategies based on scientific nursing theory that promotes physical, psychosocial, emotional, and spiritual well-being. Familiar with the concepts and needs of patients/families who are facing death and dying.
**Primary Responsibilities:**
+ Makes the initial nursing evaluation in determining eligibility for hospice services during visit within forty-eight (48) hours of referral
+ Identifies the patient's/family's physical, psychosocial, and environmental needs and re-assesses as needed, no less than every fifteen (15) days
+ Initiates and coordinates the plan of care
+ Documents problems, appropriate goals, interventions, and patient/family response to hospice care
+ Collaborates with the patient/family, attending physician and other members of the IDG in providing patient and family care daily
+ Instructs and supervises the patient/family in self-care techniques when appropriate
+ Maintains accurate and relevant clinical notes regarding the patient's condition 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 and unrestricted RN licensure in the state of practice
+ 1+ years of clinical experience
+ Current CPR Certification
+ Current driver's license, valid vehicle insurance, and access to a dependable vehicle, or public transportation
+ Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client
**Preferred Qualifications:**
+ Able to work independently
+ Good communication, writing, and organizational skills
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 $58,800 to $105,000 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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$58.8k-105k yearly 4d ago
RN Case Manager Hospice
Unitedhealth Group 4.6
Columbus, OH jobs
Explore opportunities with Caretenders Hospice, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.**
As the RegisteredNurse Case Manager, you will assume full nursing responsibility for the delivery of the Plan of Care for each hospice patient. Continuously evaluating personal and professional performance and making necessary changes to increase productivity and quality of care delivered. You'll also develop the patient's Plan of care in collaboration with other professionals and implement treatment strategies based on scientific nursing theory that promotes physical, psychosocial, emotional, and spiritual well-being. Familiar with the concepts and needs of patients/families who are facing death and dying.
**Primary Responsibilities:**
+ Makes the initial nursing evaluation in determining eligibility for hospice services during visit within forty-eight (48) hours of referral
+ Identifies the patient's/family's physical, psychosocial, and environmental needs and re-assesses as needed, no less than every fifteen (15) days
+ Initiates and coordinates the plan of care
+ Documents problems, appropriate goals, interventions, and patient/family response to hospice care
+ Collaborates with the patient/family, attending physician and other members of the IDG in providing patient and family care daily
+ Instructs and supervises the patient/family in self-care techniques when appropriate
+ Maintains accurate and relevant clinical notes regarding the patient's condition 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 and unrestricted RN licensure in the state of practice
+ 1+ years of clinical experience
+ Current CPR Certification
+ Current driver's license, valid vehicle insurance, and access to a dependable vehicle, or public transportation
+ Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client
**Preferred Qualifications:**
+ Able to work independently
+ Good communication, writing, and organizational skills
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 $58,800 to $105,000 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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._
$58.8k-105k yearly 37d ago
Field Nurse Case Manager
Unitedhealth Group Inc. 4.6
Grove City, OH jobs
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere.
As a team member of our Optum At Home product, together with an interdisciplinary care team we help patients navigate the health care system, and connect them to key support services. This preventive care can help patients stay well at home.
We're connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.
RegisteredNurses in the Optum at Home program work with patients primarily in their home setting. They perform as part of a care team including a Nurse Practitioner, Behavioral Health Advocate, Care Navigator and other supporting team members. They deliver role appropriate patient care through in-home visits, telephonic outreach and consultations, and interdisciplinary team activities.
The Field Case Manager RN may perform care and counsel of the ill, injured, or infirm, in the promotion and maintenance of health with individuals, groups, or both throughout the life span. They help to manage health problems and coordinate health care for the Optum at Home patients in accordance with State and Federal rules and regulations and the nursing standards of care. This includes (but is not limited to) assessment of health status, development and implementation of plan of care, and ongoing evaluation of patient status and response to the plan of care. Clinical management is conducted in collaboration with other care team members.
Primary Responsibilities:
* Reports to RN Manager
* Assess the health status of members as within the scope of licensure and with the frequency established in the model of care
* Establish goals to meet identified health care needs
* Plan, implement and evaluate responses to the plan of care
* Work collaboratively the multidisciplinary team to engage resources and strategies to address medical, functional, and social barriers to care
* Works closely with mental health clinicians to help bridge the gap between mental and physical health
* Consult with the patient's PCP, specialists, or other health care professionals as appropriate
* Assess patient needs for community resources and make appropriate referrals for service
* Facilitate the patient's transition within and between health care settings in collaboration with the primary care physician and other treating physicians
* Completely and accurately document in patient's electronic medical record
* Provide patients and family members with counseling and education regarding health maintenance, disease prevention, condition trajectory and need for follow up as appropriate during each patient visit
* Verify and document patient and/or family understanding of condition, plan of care and follow up recommendations
* Actively participate in organizational quality initiatives
* Participate in collaborative multidisciplinary team meetings to optimize clinical integration, efficiency, and effectiveness of care delivery
* Maintain credentials essential for practice, to include licensure, certification (if applicable) and CEUs
* Demonstrate a commitment to the mission, core values and goals of UnitedHealthcare and its healthcare delivery including the ability to integrate values of compassion, integrity, performance, innovation and relationships in the care provided to our member
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.
Years of post-high school education can be substituted/is equivalent to years of experience.
Required Qualifications:
* Current unrestricted licensure as RN in Ohio
* 2+ years of relevant experience
* Experience in assessing the medical needs of patients with complex behavioral, social and/or functional needs
* Demonstrated ability to work with diverse care teams in a variety of settings including non-clinical settings (primarily patient homes)
* Proven solid computer skills, including use of electronic medical records
* Ability to travel 100% of the time for field-based work within 60 miles of residence
* Valid driver's license
* Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
Preferred Qualification:
* Field based experience
* Case management experience
* Proven effective time management and communication skills
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 $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
$58.8k-105k yearly 26d ago
Registered Nurse Case Manager Hospice - PRN
Unitedhealth Group Inc. 4.6
Moraine, OH jobs
Explore opportunities with Caretenders Hospice, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.
#LHCJobs
As the RegisteredNurse Case Manager, you will assume full nursing responsibility for the delivery of the Plan of Care for each hospice patient. Continuously evaluating personal and professional performance and making necessary changes to increase productivity and quality of care delivered. You'll also develop the patient's Plan of care in collaboration with other professionals and implement treatment strategies based on scientific nursing theory that promotes physical, psychosocial, emotional, and spiritual well-being. Familiar with the concepts and needs of patients/families who are facing death and dying.
Primary Responsibilities:
* Makes the initial nursing evaluation in determining eligibility for hospice services during visit within forty-eight (48) hours of referral
* Identifies the patient's/family's physical, psychosocial, and environmental needs and re-assesses as needed, no less than every fifteen (15) days
* Initiates and coordinates the plan of care
* Documents problems, appropriate goals, interventions, and patient/family response to hospice care
* Collaborates with the patient/family, attending physician and other members of the IDG in providing patient and family care daily
* Instructs and supervises the patient/family in self-care techniques when appropriate
* Maintains accurate and relevant clinical notes regarding the patient's condition
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 and unrestricted RN licensure in the state of practice
* 1+ years of clinical experience
* Current CPR Certification
* Current driver's license, valid vehicle insurance, and access to a dependable vehicle, or public transportation
* Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client
Preferred Qualifications:
* Able to work independently
* Good communication, writing, and organizational skills
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 $58,800 to $105,000 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.
UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$58.8k-105k yearly 26d ago
Registered Nurse Case Manager Hospice - PRN
Unitedhealth Group 4.6
Moraine, OH jobs
Explore opportunities with Caretenders Hospice, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.**
**\#LHCJobs**
As the RegisteredNurse Case Manager, you will assume full nursing responsibility for the delivery of the Plan of Care for each hospice patient. Continuously evaluating personal and professional performance and making necessary changes to increase productivity and quality of care delivered. You'll also develop the patient's Plan of care in collaboration with other professionals and implement treatment strategies based on scientific nursing theory that promotes physical, psychosocial, emotional, and spiritual well-being. Familiar with the concepts and needs of patients/families who are facing death and dying.
**Primary Responsibilities:**
+ Makes the initial nursing evaluation in determining eligibility for hospice services during visit within forty-eight (48) hours of referral
+ Identifies the patient's/family's physical, psychosocial, and environmental needs and re-assesses as needed, no less than every fifteen (15) days
+ Initiates and coordinates the plan of care
+ Documents problems, appropriate goals, interventions, and patient/family response to hospice care
+ Collaborates with the patient/family, attending physician and other members of the IDG in providing patient and family care daily
+ Instructs and supervises the patient/family in self-care techniques when appropriate
+ Maintains accurate and relevant clinical notes regarding the patient's condition 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 and unrestricted RN licensure in the state of practice
+ 1+ years of clinical experience
+ Current CPR Certification
+ Current driver's license, valid vehicle insurance, and access to a dependable vehicle, or public transportation
+ Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client
**Preferred Qualifications:**
+ Able to work independently
+ Good communication, writing, and organizational skills
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 $58,800 to $105,000 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._
_UnitedHealth Group 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._
_UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._