This is a field based position traveling to physician practices. Case managers review charts (paper and electronic - EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Case managers primarily work at physician practices on a daily basis. If you are located in Connecticut or Rhode Island, you will have the flexibility to telecommute* as you take on some tough challenges. This role is based out of the employee's home but is required to travel to local provider offices at least 25% of the time. **Primary Responsibilities:** + Provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation. No direct patient care. + May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols + May interact with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed . + Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice. + Partner with the practice's administrative and clinical staff while managing patient appointments and data between visits. + Create and maintain a professional and supportive relationship with the patient, provider and office staff + Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services + Assists the member to access community, Medicare, family and other third-party resources as appropriate + Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the care needs for the member + Provides education to members regarding health care needs and available services + Works to facilitate member compliance with their care/treatment plan and to ensure continuity of care + Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address + Documents all care coordination activities and interventions in the member's health plan clinical record + Maintains a focus on timely, high-quality customer service + Maintains the confidentiality of all sensitive information You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Current, unrestricted RN license in the State of residence + 3+ years of healthcare industry experience + 3+ years of experience as a Registered Nurse + Strong communication and presentation skills + Strong relationship building skills with clinical and non-clinical personnel + Strong problem-solving skills + Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills + Experience retrieving data from EMRs (electronic medical records) + Must be able to travel to provider offices within service area, may require up to 1 hour radius for travel + An area designated in your home that is distraction free to utilize as a home office + Access to high speed internet via DSL/cable **Preferred Qualifications:** + Strong knowledge of the Medicare market + Experience working for a health plan and/or within a provider office + Case Management experience including Certification in Case Management + Knowledge base of clinical standards of care, preventive health, and Stars measures + Experience with HEDIS Quality Measures + Experience with CMS Quality Measures + Experience in managed care + Experience with network and provider relations/contracting + Experience with navigating and analyzing reports in Microsoft Excel + Medicaid, Medicare, Managed Care experience + Prior Physician Office experience **Careers with Optum.** Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world?s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do **your life's best work.(sm)** *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy _Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._ Keywords: RN, Registered Nurse, HEDIS, STARS, strategy, provider, gaps in care, quality measures, case manager, Connecticut, Rhode Island Associated topics: ambulatory, cardiothoracic, care, care unit, domiciliary, hospice, psychatric, psychiatric, recovery, tcu
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.