This RN Case Manager role will be working with the Medicaid QUEST program that primarily serves women & children eligible for Medicaid benefits. The member contacts will primarily be telephonic; the Care Manager also occasionally meets the member in their home or other provider-based setting.Apply for this position with your eyes wide open. Click here to view the Realistic Job Preview: UHC Community & State Field_Based_Case_Manager.pdfResponsibilities: Develop and maintain excellent performance and quality service for the HI QUEST Care Management team.
Maintain a focus on customer service through policy and program decisions and consider impact of these activities on the members.
Facilitate interdepartmental communication as needed for integration purposes.
Facilitate problem resolution with members, providers, and other agencies or entities as needed.
Conduct initial and follow-up assessments within designated timeframes on member's identified as having complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial
Assess the member's current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatment plan
Engage member, family, caregivers, and healthcare providers to assure that a well-coordinated treatment plan is established.
Utilize holistic approaches to member care and integrates member's life and motivational goals into the treatment plan.
Prioritize care needs, set goals and develop a treatment plan (or plan of care) that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation.
Track the member's health status and progress in achieving clinical and personal goals.
Initiate PRN calls when key gaps are identified that require additional nursing follow-up.
Provide education, information, direction, and support related to care goals of members
Coordinate acquisition and proper use of medical equipment, initially and on an ongoing basis
Communicate with members, families, caregivers, physicians, and other service providers to coordinate the care needs for member
Work to facilitate member compliance and to ensure continuity of care
Conduct outbound calls to assess members' current health status
Identify gaps or barriers in treatment plans
Provide patient education to assist with self management
Interact with Medical Directors on challenging cases
Coordinate care for members
Make referrals to outside sources
Coordinate services as needed (home health, DME, etc)
Educate members on disease processes
Encourage members to make healthy lifestyle changes
Document and track findings
Make 'welcome home' calls to ensure that discharged members receive the necessary services, resources, and education to avoid unnecessary readmissions
UnitedHealthcare Community & State is part of the family of companies that make **MEMBERS ONLY**SIGN UP NOW***. one of the leaders across most major segments of the US health care system.If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Clinical Registered Nurse with current, unrestricted licensure in the state of Hawaii required
Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements preferred
Reliable transportation and the ability to travel within an assigned territory as needed.
5 years Clinical background required (experience in behavioral health, complex case, or community healthcare, woman's health, pediatric experience is preferred)
Experience in case management preferred
Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Additional assets preferred: Bilingual skills a plus
Bachelors degree in Science or equivalent work experience required; Masters degree preferred
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V**MEMBERS ONLY**SIGN UP NOW***. is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.