AmeriChoice 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.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
The RN Case Manager will identify, coordinate, and/or provide appropriate levels of care under the direct supervision of an RN or MD. This job function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. This candidate will be responsible for providing health education, coaching and treatment decision support for members. Generally, work is self-directed and not prescribed. The successful RN Case Manager will have experience working with less structured, more complex issues; will serve as a resource to others; will assess and interpret customer needs and requirements while identifying solutions to non-standard requests and problems; will work with minimal guidance on all but the most complex tasks; will translate concepts into practice; and will explain and inform others on difficult issues. Other responsibilities include the following:
Customer Service
Develop and maintain excellent performance and quality service for the management team.
Maintain a focus on the customer service through policy and program decisions and consider impact of these activities on the members.
Facilitate interdepartmental communication as needed for integration purposes.
Facilitate problem resolution with members, providers, and other agencies or entities as needed.
Clinical Application
Conduct initial and follow-up assessments within designated timeframes on patients identified as having highest risk complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial)
Assess the patient's current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatment plan
Engage patient, family, caregivers, and healthcare providers to assure that a well-coordinated treatment plan is established.
Utilize holistic approaches to patient care and integrates patient's life and motivational goals into the treatment plan.
Prioritize care needs, set goals and develop a treatment plan (or plan of care) that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation.
Track the patient's health status and progress in achieving clinical and personal goals.
Initiate face to face visit and PRN calls when key gaps are identified that require additional nursing follow-up.
Provide education, information, direction, and support related to care goals of patients
Coordinate acquisition and proper use of medical equipment, initially and on an ongoing basis
Communicate with patients, families, caregivers, physicians, and other service providers to coordinate the care needs for the patient
Work to facilitate patient compliance and to ensure continuity of care
Monitor and evaluate the patient's response to treatment(s)
Collaborate with the attending physicians and Medical Director to revise treatment plans as needed
Document assessments, interventions, and follow-up on disease management activities
Regularly assess the effectiveness and quality of services provided to patients by analyzing outcomes (clinical, functional, and financial)
Maintain a focus on timely, quality customer service
Provides case management and education services in the community, at a provider location or the enrollee's home to address gaps in care and unmet needs
Quality Improvement
Maintain the confidentiality of sensitive information.
Complete all Ethics and Integrity education programs.
Use company resources appropriately (e.g., technology, supplies).
WORK FROM HOME!
Qualified applicants will live near an AmeriChoice office in either Phoenix or Tucson.
Employees may travel to nearest office location for training and/or meetings as required.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.
Registered Nurse (RN) with current licensure required
Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements, is a plus
3+ years clinical background plus experience in behavioral health and complex, community case management is desired (home care/field based case management experience preferred).
A minimum of 1 year case management experience required
Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
Bilingual a plus.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth 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.
