TRICARE Behavioral Health Utilization Manager
UnitedHealth Group - Honolulu, HI

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UnitedHealthcare Military and Veterans is currently seeking a Behavioral Health Case (CM). As a Case Manager, you will be responsible for working with a multidisciplinary team providing clinical case management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating. This position provides telephonic case management and education in support of TRICARE beneficiaries. Our mission is to help people live their lives to the fullest. We live our values are Integrity, Compassion, Relationships, Innovation, and Performance.

Primary responsibilities:
Educating and supporting the individual through telephonic assessment and expert clinical management interventions

Evaluating delays in care, coordinates with Utilization Management team facilitating discharge planning, and arranging for alternative care services to facilitate timely and appropriate discharge

Documenting 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 related to his/her disease condition

Develops CM care plan in collaboration with beneficiary/caregiver/provider in order to promote optimal health

Collaborates with specialists, physicians, and medical directors to provide the necessary care and cost efficient care for the beneficiary related to their condition

Assesses the effectiveness and quality of services provided related to clinical, functional, and outcomes

Consulting and collaborating with Medical Surgical CM colleagues on Bio/Psycho/Social assessments and service plans in a multidisciplinary team.

Adheres to all ethical, legal/regulatory and accreditation standards


Current, unrestricted RN license in your state of residence; or Licensed as a Clinical Social Worker at the highest level in your state is required

Master’s Degree Required

Experience in both medical and behavioral settings preferred

At least 5 years of experience in a hospital setting, acute care, outpatient direct care experience OR experience as a telephonic Case Manager managing disease conditions

A minimum of 3 years of case management experience

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

Excellent written and verbal communication skills

T eamwork skills

Detail oriented and highly organized

Coaching skills

Additional Preferred Assets:
Prior telephonic Disease Management experience

Case Management Certification (CCM) Preferred or may obtain within 18 months

Strong organizational skills and ability to multi-task

Prior military case management program experience

Prior military service or family military service

Prior experience in start-up environments

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 testing.

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