Case Manager RN - Tennessee statewide travel required - Sickle Cell at Nashville

Job Description

The Case Manager RN is responsible for facilitating, promoting and advocating for the members ongoing self-sufficiency and independence. Additionally, theCase Manager is responsible for sustaining the natural supports of the member. This includes but is not limited to assessing the availability of natural supports, representative or family members to ensure the ongoing mental and physical health of those natural supports. This position will focus on members with Sickle Cell. Grand Region Travel up to or less than 75%Statewide Travel 5 - 25%Territory:Primarily Nashville, with travel (possible overnight) to Memphis and ChattanoogaConduct thorough and objective initial and ongoing face-to-face assessments of the member within specific mandated intervals to determine current status and needs, including physical, behavioral, functional, psychosocial and financial and health status expectationConducttelephonic and face-to-face and other additional assessments as needed to address member change in conditionIdentify members with the potential for high-risk complications and coordinate the appropriate supported self care in conjunction with the member and care coordination teamAct as an advocate for an individuals care needs by identifying and communicating opportunities for care interventions, including identifying and addressing functional deficits and gaps in careDevelops member specific Plan of Care that will be utilized to obtain authorizations for appropriate home and community based services, collaborating with CMA staff to obtain authorization for those services and confirms that services are being provided and the members needs are being metwhile transitioning from nursing facility to homeManagement of critical transitions, supporting legacy discharge planning staff with member transition to the home settingFor members transitioning to a setting other than a community-based residential alternative (CBRA) setting, monitor the initiation and daily provision of services in accordance with the members plan of care and take the immediate action to resolve gaps in careDevelop and implement targeted strategies to improve health, functional or quality of life outcomes, such as disease management or pharmacy managementServe as a point of contact for coordination of all physical health, behavioral health and other home and community based servicesProactively educate members about the program, including opportunities for consumer direction of HCBS and obtain necessary consents for participationCoordinate with the Fiscal Employer Agent (FEA) for consumer direction members, as neededMonitor hospitalizations and institutional facility admissions and re-admissions to identify issues and implement strategies to improve outcomesProvide assistance in resolving concerns about service delivery or providersCoordinate with members primary care provider, specialists and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care;Compare members plan of care to establish pathways to determine variances and then intervene as indicatedRoutinely assess and monitor members status, needs and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to their plan of care, providers and/or services to promote better outcomesReport quantifiable impact, quality of care and/or quality of life improvements as measured against the care coordination goalsEstablish and maintain professional working relations with referral sources, community resources and care providersCollaborates with the peers on member admissions, transitioning and/or discharge planning

Job Requirements

Requirements: Registered Nurse (RN)with active license in the state of Tennessee 3+ years of clinical experience 5+ years of experience working in a healthcare environment Proficient computer skills including the ability to type and talk at the same time and toggle between multiple screens Ability to travel statewide as needed with possible overnight stays.Additional Assets Preferred:3+ years of experience providing care coordination to persons receiving long-term care and/or home and community based services and an additional 2+ years of work experience in managed and/or long-term care settings Social Work experienceWorking experience with rare conditions, Sickle Cell, Hematology, OncologyWorking knowledge of Medicare/Medicaid regulations Case management of Medicaid Waiver populations Previous field based work experienceBilingual English/Spanish OptumHealth 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.OptumHealth helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their health care needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.At OptumHealth, you will perform within an innovative culture thats focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact thats greater than youve ever imagined.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth 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.Job Keywords: RN, nurse, registered nurse, case manager, sickle cell, hematology, oncology, TN
Country: USA, State: Tennessee, City: Nashville, Company: UnitedHealth Group.