UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group 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.
As a part of our continued growth, we are searching for a Nurse Advocate-Case Manager to join our team!
***This is a field-based position and requires travel to the Baton Rouge, Lafayette and Thibodaux areas â€“ mileage reimbursable ***
Nurse Advocate-Case Manager basic responsibilities:
- Works directly with Providers offices to help them become/retain their NCQA certification of a â€˜Patient Centered Medical Homeâ€™ practice
- Work on-site with assigned Medical Home practice clinical team in managing high risk members to ensure they are seen by their PCP as needed and meet goals.
- Support continuum of member care by helping Providers in identifying members in need of health education, case management, etc.
- Solicit identification of barriers the office faces in contacting and providing care to higher risk members (recent ER visit or hospitalization event)
- Assisting Providers offices with ensuring that follow-up appointments are scheduled with members who have been recently hospitalized in a timely manner
- Review Medical Home Registry updates daily to identify any unplanned ER visits or Admissions for High Risk patients and coordinate to return patient to primary care
- Follow up with Specialists to ensure referrals to specialist appointments are completed and specialist visit documentation is provided to PCP timely and the patient returns for a primary care follow up visit.
- Collaborate with local hospital UM Nurse Staff and Transition Nurses for transitional needs of high risk patients into medical home practices.
- Maintain and support ongoing monitoring and compliance of policies and procedures.
- Current RN licensure in the State of Louisiana
- 3 or more years of hands-on clinical experience including: inpatient, ICU, medical/surgical
- Strong computer skills: MS Office and EMR
- Ability to travel locally to physician offices; valid driver's license, insurance and reliable transportation.
- 3 or more years of Outpatient clinical experience
- 2 or more years of Pediatric experience
- Case Management experience and a CCM
- Managed Care experience is preferred
- BSN or a Bachelorâ€™s degree in a related field
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 countryâ€¦
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.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group 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.
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