RN Field Case Manager - North Houston, TX

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)As a Senior Field-Based Case Manager, you'll wear many hats, and work in a variety of environments. Sometimes, you'll interact with members leaving the hospital - possibly with new medications or diagnoses. Or perhaps you'll perform home visits, assisting members with safe, effective transitions from care environments to where they live. You may also act as an intermediary between providers and members - serving in numerous roles, such as educator, evaluator, service coordinator, community resource researcher and more. The result? Fewer hospitalizations, ER visits and costly service gaps; and a less stressed, more effective health care system for us all. Want more flexibility, want more autonomy? Work from your own home and coordinate a visiting schedule that is mutually beneficial to you and the members we serve. If you are located in the northern part of Houston, TX, you will have the flexibility to telecommute* as you take on some tough challenges. Primary Responsibilities:

• Visit Medicaid members in their homes and / or other settings, including community centers, hospitals or providers' offices
• Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
• Support members with condition education, medication reviews and connections to resources
• Completes all initial and annual service planning activities and verifies, authorizes, coordinates and monitors services
• Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
• Ensure LTSS and clinical programs are in place according to members wants and needs to include functional, medical, behavioral and social needs
• Support members desires to live in the least restrictive setting as possible
• Assist members with the transition from a care facility back to their home

Once appropriate to go back into the field, expect to spend about 80% of your time in the field visiting our members in their homes or in long-term care facilities. You’ll need to be flexible, adaptable and, above all, patient in all types of situations.
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 Texas
• RUG certification or the ability to obtain within 30 days of employment
• 4+ years of clinical experience in a hospital, acute care, home health / hospice, direct care or case management, able to quickly identify needs and issues
• Knowledge or experience with Medicaid, Medicare or managed care in long-term care, Long Term Services and Supports, home health, hospice, behavioral, public health or assisted living environment
• Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
• You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role

Preferred Qualifications:

• Experience in case management and / or certification in case management (CCM)
• Home care / field based clinical experience
• Experience in Home & Community based or Long Term Care Services delivery
• Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs, Adult and / or Children with complex needs
• Understanding of Waiver benefits and service plan
• Bilingual skills
• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV / AIDS and high - risk pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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.
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