TRICARE NICU RN Nurse Case Manager – Honolulu, Hawaii
UnitedHealth Group - Honolulu, HI

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UnitedHealthcare Military and Veterans is currently seeking a NICU Case Manager, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating. This position provides telephonic support of families receiving services through the neonatal intensive care unit (NICU). Our mission is to help people live their lives to the fullest. Our values are Integrity, Compassion, Relationships, Innovation, and Performance.

Primary responsibilities:
  • Educating and supporting the family unit through telephonic assessment and expert clinical interventions
  • Evaluating delays in care, facilitating discharge planning, and arranging for alternative care services to facilitate timely and appropriate discharge
  • Collaborating with hospital staff and other clinical programs to enhance the quality and efficiency in healthcare delivery
  • Document all clinical information in accordance with UnitedHealthcare Military & Veterans policies and procedures in the member's electronic medical record.
  • Assess and interprets beneficiary needs, gaps, and requirements
  • Identifies solutions to non-standard request and problems
  • Solves moderately complex problems and/ or conducts moderately complex analyses
  • Develops care plan in collaboration with beneficiary/caregiver/provider
  • Works with minimal guidance, seeks guidance on only the most complex tasks
  • Translates concepts into practice
  • Provides explanations and information to others on difficult issues
  • Coaches, provides feedback, and guides others
  • Collaborates with specialists, physicians, and medical directors to provide the necessary care and cost efficient care for the beneficiary
  • Assesses the effectiveness and quality of services provided related to clinical, functional, and financial impact and outcomes
  • Coordinating services as needed (home health, DME, etc.)
  • Educating members on disease processes
  • Assist with projects and/or assignments designated by the Team Leader, Supervisor or Manager
  • Adhere to the timeframes surrounding contractual terms as related to obtaining clinical information, communication with providers and internal disciplines
  • Refer all cases that fall outside of standard criteria to the Medical Director for review, per UnitedHealthcare Military & Veterans policy and procedure
  • Adheres to ethical, legal/regulatory and accreditation standards
  • Current, unrestricted RN license in your state of residence
  • At least 3 years of experience in a hospital setting managing high-risk level II or III NICU patients
  • United States Citizenship
  • Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86.
  • Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment
Additional Preferred Assets:
  • Bachelor's Degree in Nursing
  • 5 years of case management experience
  • Case Management Certification (CCM), ability to obtain within 18 months
  • Strong organizational skills and ability to multi-task

As a requirement of UnitedHealth Group’s contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86, (the National Agency Check or “NAC”). Successful completion of the NAC process is a requirement for continued employment in this role. NAC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense. Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received. Failure to obtain final NAC approval will result in termination from this role.

Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. That’s why UnitedHealthcare is the organization that’s called on to serve them and their loved ones. We’re all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. It’s a genuine opportunity to do your life’s best work.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.

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 testin

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