Field RN Service Coordinator 1 - Case Manager - Remote in El Paso Texas

Telephone Case Manager RN

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today!

If you are located in El Paso, TX you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Conducting telephonic or face to face holistic evaluations of Member's individual dynamic needs and preferences gathering relevant data and obtaining further information from Member/family
• Provides education and support to Member/LAR on options of Consumer Directed, or Service-Related delivery models as applicable
• Performs initial assessments and follow-up assessments and outreach calls within the time specified as part of contractual guidelines or per Member/family/provider request
• Identifies members for high-risk complications and coordinates care with the member and the health care team
• Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefit
• Assess, plan, and implement care strategies that are individualized for each member and directed toward the most appropriate, least restrictive level of care
• Utilize both company and community-based resources to establish a safe and effective case management plan for members
• Collaborate with member, family, and healthcare providers to develop an individualized plan of care
• Identify and initiate referrals for social service programs, including financial, psychosocial, community, and state supportive services
• Manage care plan throughout the continuum of care as a single point of contact
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team
• Utilize approved clinical criteria to assess and determine appropriate level of care for members
• Document all member assessments, care plan and referrals provided
• Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care
• Understand insurance products, benefits, coverage limitations, insurance, and governmental regulations as it applies to the health plan
• Monitor services being delivered to ensure timeliness, appropriateness, and satisfaction in meeting Member needs
• Reports medically complex cases to appropriate roles as necessary for review and problem solving
• Maintains status on face-to face- and telephonic visit requirements for assigned Members

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:

• Graduate of an accredited school of nursing
• Current unrestricted RN license in Texas
• 3+ years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities as a Service Coordinator, Case Management, or similar role; or any combination of education and experience, which would provide an equivalent background
• 2+ years of experience working within the community health setting in a health care role
• 2+ years of experience working in a community health, clinical, hospital, acute care, direct care, or case management setting
• 2+ years of experience working with MS Word, Excel, and Outlook
• Demonstrated knowledge of specific case management processes, and person-centered care practice
• Demonstrated knowledge of all clinical resources available to patients both inpatient and outpatient
• Proven excellent verbal and written communication skills
• Proven analytical decision making and judgment skills
• Demonstrated ability to function as a clinical care team leader
• Proven data Entry and Word Processing Skills
• Ability to travel in assigned region to visit Medicaid members in their homes and / or other settings, including community centers, hospitals etc. This would be in the El Paso TX area.
• Bilingual English and Spanish
• Reliable transportation with valid driver's license with good driving record

Preferred Qualifications:

• Bachelor's Degree in nursing
• CCM/RUG Certified
• 2+ years of experience working with Medicaid Waiver populations
• Experience with electronic charting
• Experience with arranging community resources
• Field-based work experience
• Behavioral Health Experience
• Experience in managing populations with complex medical or behavioral needs

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.