Positions in this function include RN (with current licensure) and BSW/LSW roles that identify, coordinate, or provide appropriate levels of care under the direct supervision of an RN or MD. Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for members.
- Conduct comprehensive member assessments.
- Engage members either face to face or telephonically to have a discussion about their health
- Collaborate with member to create solutions to overcome barriers to achieving health care goals
- Provide individualized education on preventative healthcare measures
- Review plan benefits and identify appropriate programs and services based on health needs and benefits
- Engage member/providers to participate in the assessment process and collaboratively develop plan of care based on their individual needs, preferences, and objectives
- Coordinate member access to health-related programs, services, and/or providers
- Document information in relevant systems
- Utilize techniques to help member identify and understand intrinsic goals
- Coordinate with clinical staff to facilitate member care and/or services
- Facilitate member choice
- Determine and assist in maintaining member eligibility
- Bachelor's of Social Work or current and unrestricted Hawaii RN licensure
- A minimum of 1 year of experience with Medicaid/Medicare populations, including LTC and TANF/CHIP
- A minimum of 2 years of clinical or service coordination experience applicable to the Medicaid managed care population
- A minimum of 2 years of experience in field-based case management
- At least 6 months of experience in Utilization Management (acute and/or HCBS)
- Proficient in the use of software applications including, but not limited to MS Office Suite (Outlook, PowerPoint, Excel, Word, Project)
- Reliable vehicle, current and unrestricted driver's license, and proof of auto insurance
- BSN, MSW or licensed social worker preferred
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.
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.
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.
UnitedHealth Group - 14 months ago