Utilization Case Manager RN - In-Home Services - Milwaukee, WI 2383434 | Milwaukee, Wisconsin | Remote

Utilization Case Manager

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Utilization Case Manager serves Milwaukee County with occasional coverage in surrounding counties. This position offers the flexibility to work from the office and at home with field-based work in the local community approximately 25% of the work week.

This role requires you to reside within a commutable distance of Milwaukee, WI and surrounding areas.

Primary Responsibilities:

• Making outbound calls to assess members' current health status
• Conducting face to face assessments in the member's home
• Assisting members in identifying unmet needs
• Documenting assessment details and applying State guidelines to requests for services
• Documenting and tracking findings
• Identifying gaps or barriers in treatment plans
• Providing patient education to assist with self- management
• Interacting with Medical Directors on challenging cases
• Coordinating care for members
• Making referrals to outside sources
• Coordinating services as needed (home health, DME, etc.)
• Educating members on disease processes
• Encouraging members to make healthy lifestyle changes

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 Wisconsin
• 2+ years of experience in a hospital setting, acute care, direct care experience or experience as a Home Health Case Manager
• Basic level of experience with Microsoft Office and other electronic medical record applications
• Reliable transportation to travel to member's homes within the geographical area
• Willing to travel up to 25% to member homes

Preferred Qualifications:

• Home Health Case Management experience
• Experience in utilization review, concurrent review and / or risk management
• Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
• Experience with the Personal Care Screening Tool (PCST) or the Long Term Care Functional Screen (LTCFS)
• A background in Medicaid / Medicare managed care
• Bilingual Spanish
• Bilingual Hmong

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.