Clinical Care Coordinator jobs at Tenet Healthcare - 112 jobs

Clinical Documentation Integrity Registered Nurse Specialist - Remote
Tenet Healthcare Corporation 4.5
Clinical care coordinator job at Tenet Healthcare
Responsible for reviewing medical records to facilitate and obtain appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality, and complexity of care of the patient, by improving the quality of the physicians' clinical documentation. Exhibits a sufficient knowledge of clinical documentation requirements, MS-DRG Assignment, and clinical conditions and/or procedures. Educates members of the patient care team regarding documentation guidelines, including the following: attending physicians, allied health practitioners, nursing, and case management. ESSENTIAL DUTIES AND RESPONSIBILITIES Include the following. Others may be assigned. 1. Record Review: * Completes initial medical records reviews of patient records within 24-48 hours of admission for a specified patient population to: (a) evaluate documentation to assign the principal diagnosis, pertinent secondary diagnoses, and procedures for accurate MS-DRG assignment, risk of mortality and severity of illness; and (b) record in business partner designated CDI tool and/or host medical record system. * Conducts follow-up reviews of patients every 24-48 hours or as needed up through discharge to support assigned working MS-DRG assignment upon patient discharge, as necessary. * Formulate physician queries regarding missing, unclear, or conflicting health record documentation by requesting and obtaining additional documentation within the health record, as necessary. * Collaborates with providers, case managers, nursing staff and other ancillary staff regarding documentation and to resolve physician queries prior to discharge. 2.CDI * Communicates/Completes Clinical Documentation Integrity (CDI) activities and coding issues (lacking documentation, physician queries, etc.) for appropriate follow-up, provider education and DRG Miss-Match reconciliation. * Assists with Provider education, rounding and communication regarding open queries for resolution. 3. Professional Development: Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD10-CM and PCS coding. Attends CDI Boot camp, CDI/coding trainings annually and quarterly for inpatient coding. Attends monthly education lecture series (MELS) and all CDI/coding assigned learn share modules as well as any additional required CDI education. 4. Assist in training department staff new to CDI 5. Performs other duties as assigned KNOWLEDGE, SKILLS, ABILITIES To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * CDI Specialist must display teamwork and commitment while performing daily duties * Must demonstrate initiative and discipline in time management and medical record review. * Travel may be required to meet the needs of the facilities. * Proficient knowledge of disease pathophysiology and drug utilization * Intermediate knowledge of MS-DRG classification and reimbursement structures * Critical thinking, problem solving and deductive reasoning skills. * Effective written and verbal communication skills * Excellent computer skills including MS Word/Excel * Knowledge of coding compliance and regulatory standards * Excellent organizational skills for initiation and maintenance of efficient workflow * Regular and reliable attendance * Capacity to work independently in facility on-site setting. * Capacity to work independently in a virtual office setting if required for specific assignment. * Exhibit flexibility as needed to meet program needs. * Understand and communicate documentation strategies. * Recognize opportunities for documentation improvement. * Formulate clinically, compliant credible queries. * Ability to successfully comply to robust auditing and CDI program monitoring * Ability to apply coding conventions, official guidelines, and Coding Clinic advice to health record documentation. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE Include minimum education, technical training, and/or experience required to perform the job. * Preferred: Acute Care nursing and/or Provider relevant experience * Zero (0) to two (2) years CDI experience * Two (2) plus years' nursing experience - Medical/Surgical/Intensive Care and/or Case/Utilization Review * Two (2) plus years' Provider experience - Medical/Surgical/Intensive Care and/or Case/Utilization Review * Graduate from a Nursing program, BSN, or graduate program; OR * Graduate from Medical Doctor and/or Foreign Medical Doctor Program CERTIFICATES, LICENSES, REGISTRATIONS * Active state Registered Nurse license; OR * Graduate MD and/or FMD license * Preferred: CDIP or CCDS PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. * Ability to sit for extended periods of time. * Ability to stand for extended periods of time. * Must be able to efficiently use computer keyboard and mouse. * Good visual acuity WORK ENVIRONMENT The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. OTHER * Must be able to travel as needed, not to exceed 10%. Compensation and Benefit Information Compensation * Pay: $72,509- $108,763 annually. Compensation depends on location, qualifications, and experience. * Management level positions may be eligible for sign-on and relocation bonuses. Benefits Conifer offers the following benefits, subject to employment status: * Medical, dental, vision, disability, life, and business travel insurance * Paid time off (vacation & sick leave) - min of 12 days per year, accrued accrue at a rate of approximately 1.84 hours per 40 hours worked. * 401k with up to 6% employer match * 10 paid holidays per year * Health savings accounts, healthcare & dependent flexible spending accounts * Employee Assistance program, Employee discount program * Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, AD&D, auto & home insurance. * For Colorado employees, Conifer offers paid leave in accordance with Colorado's Healthy Families and Workplaces Act. Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E-Verify program. Follow the link below for additional information. E-Verify: ***************************** The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations. **********
$72.5k-108.8k yearly 16d ago

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Registered Nurse (RN)
Tenet Healthcare 4.5
Clinical care coordinator job at Tenet Healthcare
Responsible for patient triage, patient education, and assisting physicians in the assessment of patient needs and treatment plan(s). Maintain chart documentation to ensure all information about patient is completed and documented correctly. Education: High School Diploma or equivalent and completion of an accredited nursing program. Experience: 2 years of clinical in a physician office. Certification: Current State RN license and CPR certification. #LI-RF1
$25k-76k yearly est. Auto-Apply 22d ago
Clinical Liaison
Lifepoint Hospitals 4.1
Ohio jobs
Clinical Liaison - Inpatient Rehabilitation Full time Your experience matters At Mercy Health Rehabilitation Hospital, we are committed to empowering and supporting a diverse and determined workforce that can drive quality, scalability, and significant impact across our hospitals and communities. In your role, you'll support those in our facilities who are interfacing and providing care to our patients and community members. We believe that our collective efforts will shape a healthier future for the communities we serve. How you'll contribute A Clinical Liaison who excels in this role: * Builds and maintains referral relationships to drive appropriate admissions to the hospital * Assist and coordinate the intake and pre-admission screening process * Perform on-site (typically in a referring facility) clinical judgment to determine the appropriateness of the patient for admission * Communicates rehabilitation and facility options to patients and families. Communicates with patients, determines admission appropriateness, and assesses the patient's expectations and requirements for participation. * Secures information relating to patients' resources and benefits * Functions as initial contact for external case management and discharge planner personnel with payors and hospital facilities Why join us We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: * Comprehensive Benefits: Multiple levels of medical, dental and vision coverage with tailored benefit options for part-time and PRN employees, and more. * Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off. * Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match. * Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs). * Professional Development: Ongoing learning and career advancement opportunities. What we're looking for Applicants should have Clinical Licensure as an RN, LPN, PT, OT, SLP, or MSW and a bachelor's degree. Additional requirements include: * Previous marketing/sales experience preferred * Previous clinical experience preferred, with demonstrated skills in clinical assessment and EMR systems * Formal Sales Training preferred * Valid driver's license Connect with a Recruiter Not ready to complete an application, or have questions? Please contact Beth Bergman by emailing ******************************** EEOC Statement Mercy HealthRehabilitation Hospital is an Equal Opportunity Employer. Mercy Health Rehabilitation Hospital is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment.
$61k-76k yearly est. Easy Apply 8d ago
Clinical Liaison
Kindred Healthcare 4.1
Dayton, OH jobs
Clinical Liaison (Job Number: 550807) Description At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job SummaryConducts patient assessments to identify appropriate patients for potential admission into the system Daily follow up with patients and their decision-makers in their account(s) for consistent clinical reassessment Responsible for managing the referrals and admissions that are generated through their assigned hospitals and territories Represents ScionHealth and their assigned hospital with professionalism and maintains positive relationships with the accounts within their territory Designs and manages the marketing strategies for their assigned accounts. Identifies and contacts new and potential referral sources to grow their respective territory Conducts in-person educational meetings and conversations with referral sources, utilizing educational materials to present our specialty hospitals to referral sources Acts as liaison by coordinating transmission of clinical and benefit information between patients, decision-makers, referral sources and the ScionHealth Specialty Hospitals they serve Performs 80% or more of work outside the home, with expectation of being on-site at their respective accounts daily Essential FunctionsUses prospecting methods to generate leads including initiating personal/business contacts, sourcing expansion opportunities through existing and new accounts and educational presentations Meets the monthly goals for their assigned hospitals Expands the number of referral sources in their assigned territories Maintains current referral sources through relationship development Manages the admissions process as an ambassador for patients who meet the criteria eligibility Operates within budgeted parameters by carefully planning travel and monitoring expenses Conduct assessments in accordance with company standards Manage the referrals and admission process for their referred patients Work closely with patients and their family members to educate them on the benefits of ScionHealth HospitalsConducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards Completes clinical assessments on potential patients completing assessments to meet with standards of the DivisionMeets with patients and families to explain hospital's care and services Establishes strong and successful relationships with referral sources throughout their territory Successfully manages the Referral, Assessment and Admission ProcessAdheres to dress code, appearance is neat and clean and wears appropriate identification while on duty Completes annual health, safety, and education requirements Maintains professional growth and development Maintains confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide care to the patient population served Reports to work on time as scheduled; adheres to policies regarding notification of absence Attends all mandatory in-services and staff meetings Represents the organization in a positive and professional manner Complies with all organizational policies regarding ethical business practices Communicates the mission, ethics, and goals of the hospital, as well as the focus statement of the department Maintains current licensure/certification for position, if applicable Consistently demonstrates Guest Relation's skills to patients, physicians, visitors, employees, and any other individuals with whom they may come in contact Consistently follows departmental and hospital Health, Safety, Security, Hazardous Materials policies and procedures Knowledge/Skills/Abilities/ExpectationsApproximate percent of time required to travel: DailyMust read, write and speak fluent EnglishMust have good and regular attendance Performs other related duties as assigned Qualifications EducationAssociate's degree required; Bachelor's degree preferred Degree in marketing, communication, healthcare administration, nursing, or other related field strongly preferred Extensive healthcare sales work experience may be considered in lieu of bachelor's degree Licenses/CertificationValid driver's license Clinical license preferred; Registered Nurse (RN), Licensed Practical Nurse (LPN/LVN), Respiratory Therapist (RT) ExperienceMinimum two (2) years of former healthcare sales experience and/or minimum of two (2) years of clinical healthcare experience strongly preferred Formal sales training preferred Demonstrated understanding of Medicare, Medicaid, and other payers as related to LTACH benefits Demonstrated competence in strategic business planning and design of marketing initiatives Job: Clinical LiaisonPrimary Location: OH-Dayton-Kindred Hospital - DaytonOrganization: 4500 - Kindred Hospital - DaytonShift: Day
$50k-73k yearly est. Auto-Apply 15d ago
Care Coordinator II
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. This is a field-based role. Candidate must reside in Polk County, Arkansas. Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities. Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service May support performing service assessments/screenings for members and documenting the member's care needs Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager Provide education on benefits and resources available Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires a High School diploma or GED. Requires 1 - 2 years of related experience License/Certification: For Arkansas Total Care plan - Bachelor's degree in social science/health-related field or a high school diploma with at least one (1) year of experience coordinating care for developmentally or intellectually disabled clients or behavioral health clients. This position is designated as safety sensitive in Arkansas and requires a driver's license, child and adult maltreatment check (before hire and recurring), and a drug screen (at time of hire and recurring). Must reside in AR or border city. Travel: 30%. required This is a field-based role. Candidate must reside in Polk County, Arkansas. Pay Range: $17.50 - $27.50 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
$17.5-27.5 hourly Auto-Apply 44d 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 Registered Nurse 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 Registered Nurse 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 37d 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 Registered Nurse 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
CCAT Clinical Consultant Mid-Level Practitioner
Unitedhealth Group Inc. 4.6
Plymouth, MN jobs
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The Mid-Level Practitioner role in the Clinical & Coding Advisory Team (CCAT) is a rare opportunity to work directly within Optum Payer Operations. As a member of CCAT, you will play a vital role in helping stop fraud, waste, abuse, and error and help healthcare work better every day. The purpose of this job is to help people live their lives to the fullest by providing clinical leadership and expertise for the clinical investigation teams, including involvement in clinical reviews, provider education, high level appeals, development of clinical resources, and operations improvements. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Provide expert clinical and strategic leadership for operational teams * Assist with high level clinical reviews (e.g. appeals, peer-to-peer, arbitration, etc.) * Collaborate with clinical operations teams on complex or difficult cases * Apply clinical knowledge in the interpretation of medical policy, clinical resources, and benefit document language in the review of professional and facility pre-pay and post-pay clinical reviews * Collaborate with and educate network and non-network providers on cases and clinical coding situations in pursuit of accurate billing practices * Actively participate in regular meetings and projects focused on clinical decision-making, clinical resources, analytics, savings, and staff training * Other duties and goals assigned by the Sr. Medical Director Qualified candidates will be expected to effectively demonstrate: * Proven excellent verbal and written communications skills * Proven solid team player and team building skills * Proven solid negotiation and conflict management skills Critical Success Factors: * Solid understanding of Fraud, Waste, Abuse, and Error methodology * Solid problem-solving, negotiation and persuasion skills * Ability to effective lead, manage and deliver in a fast pace, ever changing environment * Ability to foster communications, robust collaboration, and solid partnerships among providers, clients, leaders, and clinical teams 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, active, and fully non-restricted licensed Nurse Practitioner (APRN) or Physician Assistant (PA) * 3+ years of clinical practice experience * CPT/HCPCS/ICD-9/ICD-10 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology and regulatory guidelines * Familiarity with current medical issues and practices Preferred Qualifications: * Coding Certification through AHIMA (CCS, CDIS, RHIA, RHIT) or AAPC (CIC) * 3+ years in facility (DRG and Clinical Validation Audit) reviews * 2+ years of experience in leading clinical operations within a health plan/or managed care environment to include client facing experience * Experience with Encoder and Grouper Software (3M) * Knowledge of federal (e.g., CMS) and state laws and regulations * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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.
$91.7k-163.7k yearly 13d ago
CCAT Clinical Consultant Mid-Level Practitioner
Unitedhealth Group 4.6
Plymouth, MN jobs
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The Mid-Level Practitioner role in the Clinical & Coding Advisory Team (CCAT) is a rare opportunity to work directly within Optum Payer Operations. As a member of CCAT, you will play a vital role in helping stop fraud, waste, abuse, and error and help healthcare work better every day. The purpose of this job is to help people live their lives to the fullest by providing clinical leadership and expertise for the clinical investigation teams, including involvement in clinical reviews, provider education, high level appeals, development of clinical resources, and operations improvements. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Provide expert clinical and strategic leadership for operational teams + Assist with high level clinical reviews (e.g. appeals, peer-to-peer, arbitration, etc.) + Collaborate with clinical operations teams on complex or difficult cases + Apply clinical knowledge in the interpretation of medical policy, clinical resources, and benefit document language in the review of professional and facility pre-pay and post-pay clinical reviews + Collaborate with and educate network and non-network providers on cases and clinical coding situations in pursuit of accurate billing practices + Actively participate in regular meetings and projects focused on clinical decision-making, clinical resources, analytics, savings, and staff training + Other duties and goals assigned by the Sr. Medical Director **Qualified candidates will be expected to effectively demonstrate:** + Proven excellent verbal and written communications skills + Proven solid team player and team building skills + Proven solid negotiation and conflict management skills **Critical Success Factors:** + Solid understanding of Fraud, Waste, Abuse, and Error methodology + Solid problem-solving, negotiation and persuasion skills + Ability to effective lead, manage and deliver in a fast pace, ever changing environment + Ability to foster communications, robust collaboration, and solid partnerships among providers, clients, leaders, and clinical teams 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, active, and fully non-restricted licensed Nurse Practitioner (APRN) or Physician Assistant (PA) + 3+ years of clinical practice experience + CPT/HCPCS/ICD-9/ICD-10 coding experience with a thorough knowledge of health insurance business, including knowledge of industry terminology and regulatory guidelines + Familiarity with current medical issues and practices **Preferred Qualifications:** + Coding Certification through AHIMA (CCS, CDIS, RHIA, RHIT) or AAPC (CIC) + 3+ years in facility (DRG and Clinical Validation Audit) reviews + 2+ years of experience in leading clinical operations within a health plan/or managed care environment to include client facing experience + Experience with Encoder and Grouper Software (3M) + Knowledge of federal (e.g., CMS) and state laws and regulations *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _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._
$91.7k-163.7k yearly 13d ago
Clinical Care Coordinator - Remote in Southeast Colorado and surrounding areas
Unitedhealth Group 4.6
Pueblo, CO 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 equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). As part of the UnitedHealthcare family of plans, RMHP provides innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. RMHP is continually striving to improve the health and wellness of our Members and partners in the state where we live, work, and play - because we're Colorado, too. As part of a care management team who will manage a caseload of complex members, the Clinical Care Coordinator will be the primary care manager for members with complex needs. Care coordination activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. This is a home-based position in SE Colorado with field responsibilities approximately 25% of the time. **Primary Responsibilities:** + Engage members and/or their families face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs + Develop and implement individualized, person-centered care plans inclusive of goals, opportunities and interventions aligned with a person's readiness to change to support the best health and quality of life outcomes by meeting the member where they are + Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan + Provide referral and linkage as appropriate and accepted by member (may include internal consult opportunities such as Housing Navigator, Pharmacy Team, Peer Specialist, etc. or community-based provider referrals such as PCP, specialists, medication assisted therapy referrals, etc.) + Work with community partners and stakeholders to provide comprehensive support for members with complex needs 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:** + Must meet one of the following: + Current, unrestricted independent licensure as a Social Worker + 4-Year or Higher degree in a behavioral health related field (e.g., psychology, counseling, etc.) plus 3+ years of direct experience + LPN with 5+ years of direct experience + 2+ years of experience working within the community health setting or in a health care role + 1+ year of experience with local health providers and/or community support organizations addressing the SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing / rapid re-housing assistance, etc. + 1+ years of experience with MS Office, including Word, Excel, and Outlook + Resident of Colorado + Driver's License and access to reliable transportation **Preferred Qualifications:** + Demonstrated experience / additional training or certifications in Motivational Interviewing, Stages of Change, Trauma-Informed Care, Person-Centered Care + Experience working in team-based care + Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders) + Bilingual in Spanish or other language specific to market populations + Background in Managed Care 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$28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _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._
$28.9-51.6 hourly 3d ago
Clinical Care Coordinator - Remote in Southeast Colorado and surrounding areas
Unitedhealth Group Inc. 4.6
Pueblo, CO 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Doing the right thing is a way of life at Rocky Mountain Health Plans (RMHP). As part of the UnitedHealthcare family of plans, RMHP provides innovative health insurance coverage and personalized attention to individuals of all ages and business of all sizes throughout Western and rural Colorado. RMHP is continually striving to improve the health and wellness of our Members and partners in the state where we live, work, and play - because we're Colorado, too. As part of a care management team who will manage a caseload of complex members, the Clinical Care Coordinator will be the primary care manager for members with complex needs. Care coordination activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. This is a home-based position in SE Colorado with field responsibilities approximately 25% of the time. Primary Responsibilities: * Engage members and/or their families face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs * Develop and implement individualized, person-centered care plans inclusive of goals, opportunities and interventions aligned with a person's readiness to change to support the best health and quality of life outcomes by meeting the member where they are * Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan * Provide referral and linkage as appropriate and accepted by member (may include internal consult opportunities such as Housing Navigator, Pharmacy Team, Peer Specialist, etc. or community-based provider referrals such as PCP, specialists, medication assisted therapy referrals, etc.) * Work with community partners and stakeholders to provide comprehensive support for members with complex needs 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: * Must meet one of the following: * Current, unrestricted independent licensure as a Social Worker * 4-Year or Higher degree in a behavioral health related field (e.g., psychology, counseling, etc.) plus 3+ years of direct experience * LPN with 5+ years of direct experience * 2+ years of experience working within the community health setting or in a health care role * 1+ year of experience with local health providers and/or community support organizations addressing the SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing / rapid re-housing assistance, etc. * 1+ years of experience with MS Office, including Word, Excel, and Outlook * Resident of Colorado * Driver's License and access to reliable transportation Preferred Qualifications: * Demonstrated experience / additional training or certifications in Motivational Interviewing, Stages of Change, Trauma-Informed Care, Person-Centered Care * Experience working in team-based care * Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders) * Bilingual in Spanish or other language specific to market populations * Background in Managed Care 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$28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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.
$28.9-51.6 hourly 3d ago
APC Clinical Consultant Sr, Risk Adjustment Enablement
Unitedhealth Group 4.6
Eden Prairie, MN jobs
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** **Position Summary** The Clinical Consultant Sr, Risk Adjustment Enablement, serves in a high-impact support role across two strategic domains: Risk Adjustment Infrastructure Enablement and Risk Adjustment Clinical Operations Enablement. This role is designed to provide clinical and operational support to the Risk Adjustment Infrastructure Enablement and the Risk Adjustment Clinical Ops Enablement, contributing to the execution of scalable, compliant, and clinically sound risk adjustment strategies. The consultant collaborates across coding, benefit design, vendor strategy, and home/community-based care models to ensure alignment with enterprise goals. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Support for Risk Adjustment Infrastructure Enablement + Support the development of benefit design proposals by translating clinical insights into actionable recommendations + Assist in the clinical review and validation of standardized code sets (CPT, LOINC, ICD, HCPCS, SNOMED CT, RxNorm) for reporting and billing + Collaborate with finance and quality teams to ensure incentive models align with evidence-based care + Participate in vendor evaluation and performance monitoring in partnership with enablement teams + Support for Risk Adjustment Clinical Operations Enablement + Assist in aligning clinical and operational workflows across OH Regional CDOs to support scalable risk adjustment performance + Contribute to the execution of home and community-based enablement strategies (OAH, FPM, HC) across OH businesses (excluding SCC) + Provide clinical input into documentation standards and workflow optimization + Cross-Functional Collaboration + Work closely with coding, analytics, clinical operations, and vendor teams to ensure clinical relevance and operational feasibility + Translate clinical guidance into actionable support for infrastructure and operations teams 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:** + Licensed Nurse Practitioner or Physican Assistant with clinical experience in risk adjustment, documentation, or home/community-based care + Experience/exposure collaborating with cross-functional teams including clinical, technical, and operational stakeholders + Solid understanding of Medicare Advantage, HCC models, and coding systems + Proven excellent communication and organizational skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _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._
$91.7k-163.7k yearly 13d ago
Clinical Consultant Sr, Risk Adjustment Enablement
Unitedhealth Group Inc. 4.6
Eden Prairie, MN jobs
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Position Summary The Clinical Consultant Sr, Risk Adjustment Enablement, serves in a high-impact support role across two strategic domains: Risk Adjustment Infrastructure Enablement and Risk Adjustment Clinical Operations Enablement. This role is designed to provide clinical and operational support to the Risk Adjustment Infrastructure Enablement and the Risk Adjustment Clinical Ops Enablement, contributing to the execution of scalable, compliant, and clinically sound risk adjustment strategies. The consultant collaborates across coding, benefit design, vendor strategy, and home/community-based care models to ensure alignment with enterprise goals. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Support for Risk Adjustment Infrastructure Enablement * Support the development of benefit design proposals by translating clinical insights into actionable recommendations * Assist in the clinical review and validation of standardized code sets (CPT, LOINC, ICD, HCPCS, SNOMED CT, RxNorm) for reporting and billing * Collaborate with finance and quality teams to ensure incentive models align with evidence-based care * Participate in vendor evaluation and performance monitoring in partnership with enablement teams * Support for Risk Adjustment Clinical Operations Enablement * Assist in aligning clinical and operational workflows across OH Regional CDOs to support scalable risk adjustment performance * Contribute to the execution of home and community-based enablement strategies (OAH, FPM, HC) across OH businesses (excluding SCC) * Provide clinical input into documentation standards and workflow optimization * Cross-Functional Collaboration * Work closely with coding, analytics, clinical operations, and vendor teams to ensure clinical relevance and operational feasibility * Translate clinical guidance into actionable support for infrastructure and operations teams 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: * Licensed Nurse Practitioner or Physican Assistant with clinical experience in risk adjustment, documentation, or home/community-based care * Experience/exposure collaborating with cross-functional teams including clinical, technical, and operational stakeholders * Solid understanding of Medicare Advantage, HCC models, and coding systems * Proven excellent communication and organizational skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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.
$91.7k-163.7k yearly 13d ago
Registered Nurse FT Days!
Kindred Healthcare 4.1
Dayton, OH jobs
Registered Nurse FT Days! (Job Number: 549045) Description $15K SOB!At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job SummaryProvides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient's clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential FunctionsMaintains the standard of nursing care and implements policies and procedures of the hospital and nursing department Directs, supervises, provides and evaluates nursing care provided to patients Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated Assigns nursing care team members in accordance with patient needs, team member's capabilities and qualifications Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient's medical record according to nursing standards and policies Performs assessment on all patients on admission and reassessments as per policy Makes referrals to other disciplines based on assessment Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team Assesses and reassesses pain Utilizes appropriate pain management techniques Educates the patient and family regarding pain management. Revises the plan of care as indicated by the patient's response to treatment and evaluates overall plan daily for effectiveness Performs patient care responsibilities considering needs specific to the standard of care for patient's age Receives physician's orders, ensures transcription is accurate and documents completion Administers medication utilizing the five rights of medication administration reducing the potential for medication errors Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice Performs treatments and provides services to level of licensure Treats patients and their families with respect and dignity Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families Functions as liaison between administration, patients, physicians, and other healthcare providers Interacts professionally with patient/family and involves patient/family in the formation of the plan of care Interprets data about the patient's status to identify each patient's age specific needs and provide care needed by the patient group Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors Initiates or assists with emergency measures for sudden adverse developments in patients' condition Answers telephone, paging system, patients' call lights, anticipates patients' needs, and makes rounds of assigned patients and responds as appropriate Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off Communicates appropriately and clearly to management, co-workers, and physicians Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs Participates in orientation, instruction/training of new personnel Manages and operates equipment safely and correctly Knowledge/Skills/Abilities/ExpectationsKnowledge of medications and their correct administration based on age of the patient and their clinical condition Basic computer knowledge Able to organize tasks, develop action plans, set priorities and function under stressful situations Ability to maintain a good working relationship both within the department and with other departments Approximate percent of time required to travel: 0%Must read, write and speak fluent EnglishMust have good and regular attendance Performs other related duties as assigned Qualifications EducationGraduation from an accredited Bachelor of Science in NursingAssociate Degree in Nursing or Nursing Diploma program Licenses/CertificationCurrent state licensure as Registered NurseBCLS certification required ACLS certifications preferred ExperienceMinimum six months' Medical/Surgical experience in an acute care setting preferred Job: RNPrimary Location: OH-Dayton-Kindred Hospital - DaytonOrganization: 4500 - Kindred Hospital - DaytonShift: Day
$59k-80k yearly est. Auto-Apply 53d ago
Registered Nurse RN Weekend Night Option Program
Kindred Healthcare 4.1
Lima, OH jobs
Registered Nurse RN Weekend Night Option Program (Job Number: 540377) Description $20,000 Sign-on-Bonus!At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and EvaluationDevelops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary Communicates changes in patient's clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate Participates in discharge planning process Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department Directs, supervises, provides and evaluates nursing care provided to patients Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated Assigns nursing care team members in accordance with patient needs, team member's capabilities and qualifications Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient's medical record according to nursing standards and policies Performs assessment on all patients on admission and reassessments as per policy. Makes referrals to other disciplines based on assessment Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management Revises the plan of care as indicated by the patient's response to treatment and evaluates overall plan daily for effectiveness Performs patient care responsibilities considering needs specific to the standard of care for patient's age Receives physician's orders, ensures transcription is accurate and documents completion Administers medication utilizing the five rights of medication administration reducing the potential for medication errors Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice Performs treatments and provides services to level of licensure Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families Functions as liaison between administration, patients, physicians, and other healthcare providers Interacts professionally with patient/family and involves patient/family in the formation of the plan of care Interprets data about the patient's status to identify each patient's age specific needs and provide care needed by the patient group Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors Initiates or assists with emergency measures for sudden adverse developments in patients' condition Answers telephone, paging system, patients' call lights, anticipates patients' needs, and makes rounds of assigned patients and responds as appropriate Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off Communicates appropriately and clearly to management, co-workers, and physicians Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs Participates in orientation, instruction/training of new personnel Manages and operates equipment safely and correctly Knowledge/Skills/Abilities/ExpectationsKnowledge of medications and their correct administration based on age of the patient and their clinical condition Basic computer knowledge Able to organize tasks, develop action plans, set priorities and function under stressful situations Ability to maintain a good working relationship both within the department and with other departments Approximate percent of time required to travel: 0%Must read, write and speak fluent EnglishMust have good and regular attendance Performs other related duties as assigned Qualifications Education Graduation from an accredited Bachelor of Science in Nursing Associate Degree in Nursing or Nursing Diploma program Licenses/Certification Current state licensure as Registered Nurse BCLS certification required ACLS certifications preferred Experience Minimum six months' Medical/Surgical experience in an acute care setting preferred Job: RNPrimary Location: OH-Lima-Kindred Hospital-LimaOrganization: 4851 - Kindred Hospital-LimaShift: Night
$59k-79k yearly est. Auto-Apply 60d+ ago
Registered Nurse/FT/Days
Kindred Healthcare 4.1
Lima, OH jobs
Registered Nurse/FT/Days (Job Number: 548658) Description $20,000 SIGN ON BONUS THROUGH JANUARY 2026. At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient's clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department Directs, supervises, provides and evaluates nursing care provided to patients Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated Assigns nursing care team members in accordance with patient needs, team member's capabilities and qualifications Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient's medical record according to nursing standards and policies Performs assessment on all patients on admission and reassessments as per policy Makes referrals to other disciplines based on assessment Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team Assesses and reassesses pain Utilizes appropriate pain management techniques Educates the patient and family regarding pain management Revises the plan of care as indicated by the patient's response to treatment and evaluates overall plan daily for effectiveness Performs patient care responsibilities considering needs specific to the standard of care for patient's age Receives physician's orders, ensures transcription is accurate and documents completion Administers medication utilizing the five rights of medication administration reducing the potential for medication errors Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice Performs treatments and provides services to level of licensure Treats patients and their families with respect and dignity Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families Functions as liaison between administration, patients, physicians, and other healthcare providers Interacts professionally with patient/family and involves patient/family in the formation of the plan of care Interprets data about the patient's status to identify each patient's age specific needs and provide care needed by the patient group Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors Initiates or assists with emergency measures for sudden adverse developments in patients' condition Answers telephone, paging system, patients' call lights, anticipates patients' needs, and makes rounds of assigned patients and responds as appropriate Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off Communicates appropriately and clearly to management, co-workers, and physicians Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs Participates in orientation, instruction/training of new personnel Manages and operates equipment safely and correctly Knowledge/Skills/Abilities/ExpectationsKnowledge of medications and their correct administration based on age of the patient and their clinical condition Basic computer knowledge Able to organize tasks, develop action plans, set priorities and function under stressful situations Ability to maintain a good working relationship both within the department and with other departments Approximate percent of time required to travel: 0%Must read, write and speak fluent EnglishMust have good and regular attendance Performs other related duties as assigned Qualifications EducationGraduation from an accredited Bachelor of Science in NursingAssociate Degree in Nursing or Nursing Diploma program Licenses/CertificationCurrent state licensure as Registered NurseBCLS certification required ACLS certifications preferred ExperienceMinimum six months' Medical/Surgical experience in an acute care setting preferred Job: RNPrimary Location: OH-Lima-Kindred Hospital-LimaOrganization: 4851 - Kindred Hospital-LimaShift: Day
$59k-79k yearly est. Auto-Apply 60d+ ago
Registered Nurse RN Weekend Days Option Program
Kindred Healthcare 4.1
Lima, OH jobs
Registered Nurse RN Weekend Days Option Program (Job Number: 540391) Description $20,000 Sign-on-Bonus! At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient's clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process.Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department.Directs, supervises, provides and evaluates nursing care provided to patients. Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated.Assigns nursing care team members in accordance with patient needs, team member's capabilities and qualifications.Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient's medical record according to nursing standards and policies.Performs assessment on all patients on admission and reassessments as per policy. Makes referrals to other disciplines based on assessment. Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team.Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management.Revises the plan of care as indicated by the patient's response to treatment and evaluates overall plan daily for effectiveness.Performs patient care responsibilities considering needs specific to the standard of care for patient's age.Receives physician's orders, ensures transcription is accurate and documents completion.Administers medication utilizing the five rights of medication administration reducing the potential for medication errors.Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate.Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice.Performs treatments and provides services to level of licensure.Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers.Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.Interprets data about the patient's status to identify each patient's age specific needs and provide care needed by the patient group.Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.Initiates or assists with emergency measures for sudden adverse developments in patients' condition.Answers telephone, paging system, patients' call lights, anticipates patients' needs, and makes rounds of assigned patients and responds as appropriate.Consults other departments as appropriate to provide for an interdisciplinary approach to the patient's needs.Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off.Communicates appropriately and clearly to management, co-workers, and physicians.Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs.Participates in orientation, instruction/training of new personnel.Manages and operates equipment safely and correctly.Knowledge/Skills/Abilities/ExpectationsKnowledge of medications and their correct administration based on age of the patient and their clinical condition.Basic computer knowledge.Able to organize tasks, develop action plans, set priorities and function under stressful situations.Ability to maintain a good working relationship both within the department and with other departments.Approximate percent of time required to travel: 0% Must read, write and speak fluent English.Must have good and regular attendance.Performs other related duties as assigned.Qualifications Education Graduation from an accredited Bachelor of Science in Nursing, Associate Degree in Nursing or Nursing Diploma program. Licenses/Certification Current state licensure as Registered Nurse. BCLS certification required. ACLS certifications preferred. Experience Minimum six months' Medical/Surgical experience in an acute care setting preferred. Job: RNPrimary Location: OH-Lima-Kindred Hospital-LimaOrganization: 4851 - Kindred Hospital-LimaShift: Day
$59k-79k yearly est. Auto-Apply 60d+ ago
Behavioral Health Senior Clinical Admin RN - Remote
Unitedhealth Group Inc. 4.6
Nashville, TN 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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Senior Clinical Admin Nurse will be responsible for providing individualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help individuals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Candidate must be willing to work Monday - Friday 8:00 am - 5:00 pm. Primary Responsibilities: * Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently * Educate and guide members regarding BHSUD * Assist members with adverse determinations, including the appeal process * Teach members how to navigate UMR internet-based wellness tools and resources * Outreach to membership providing pre-admission counseling to membership * Outreach to membership providing discharge planning to membership and caretakers * Track all activities and provide complete documentation to generate customer reporting * Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary medical care and community referrals as needed * Comply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databases * Contribute to treatment plan discussions * Other duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * Current and unrestricted RN compact license * 2+ years of acute nursing experience * 2+ years of behavioral health nursing experience * 2+ years of case management experience * Demonstrated basic computer proficiency (i.e. MS Word, Outlook) * Proven ability to function independently and responsibly with minimal supervision Preferred Qualifications: * Bachelor's degree in nursing * CCM * 2+ years of managed care experience * Critical care, pediatric, med-surg and/or telemetry experience * Utilization management experience * Adverse determination experience * Telecommute experience Soft Skills: * Demonstrated excellent verbal and written communication skills * Excellent customer service orientation * Proven team player and team building skills * Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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.
$60.2k-107.4k yearly 8d ago
Behavioral Health Senior Clinical Admin RN - Remote
Unitedhealth Group 4.6
Phoenix, AZ 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 equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** The Senior Clinical Admin Nurse will be responsible for providing individualized attention to UMR membership and covered families and serves to assist with navigation of the health care system. The purpose of the clinical liaison nurse is to help individuals live their lives to the fullest by supporting coordination and collaboration with multiple and external partners including consumers and their families/caregivers, medical, and other clinical teams. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Candidate must be willing to work Monday - Friday 8:00 am - 5:00 pm.** **Primary Responsibilities:** + Provide members with tools and educational support needed to navigate the health care system and manage their health concerns effectively and cost efficiently + Educate and guide members regarding BHSUD + Assist members with adverse determinations, including the appeal process + Teach members how to navigate UMR internet-based wellness tools and resources + Outreach to membership providing pre-admission counseling to membership + Outreach to membership providing discharge planning to membership and caretakers + Track all activities and provide complete documentation to generate customer reporting + Accept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary medical care and community referrals as needed + Comply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databases + Contribute to treatment plan discussions + Other duties as assigned You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current and unrestricted RN compact license + 2+ years of acute nursing experience + 2+ years of behavioral health nursing experience + 2+ years of case management experience + Demonstrated basic computer proficiency (i.e. MS Word, Outlook) + Proven ability to function independently and responsibly with minimal supervision **Preferred Qualifications:** + Bachelor's degree in nursing + CCM + 2+ years of managed care experience + Critical care, pediatric, med-surg and/or telemetry experience + Utilization management experience + Adverse determination experience + Telecommute experience **Soft Skills:** + Demonstrated excellent verbal and written communication skills + Excellent customer service orientation + Proven team player and team building skills + Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _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._
$60.2k-107.4k yearly 8d ago