Job Category:
Medical/Health
Reference Code:
311558
Position Type:
Full Time, Employee
UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.

Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.

Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Field and telephonic Case Manager opportunities-Jackson, Ridgeland, MS - Multiple locations
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

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.
 
As a Case Manager, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating.  This may include case management, disease management, coordination of care and medical management consulting.  You will also be responsible for providing health education, coaching and treatment decision support for members. Case Managers work in a variety of settings: in the community providing proactive care coordination to individuals and support to their families in person as well as in telephonic care management position. This position will require heavy telephone use.
 
Primary responsibilities:
  • Making outbound calls to assess members' current health status

  • Conducting face to face visits to members to conduct assessment and case management

  • 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

  • Documenting and tracking findings

  • Utilizing Milliman criteria to determine if patients are in the correct hospital setting

  • Making "welcome home" calls to ensure that discharged member receive the necessary services and resources


 
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.
 


Qualifications:
  • Current, unrestricted RN license in the State of Mississippi

  • 2+ years experience in a hospital setting, acute care, direct care experience

  • 1+ years case management or utilization review experience

  • Computer proficiency including the ability to type and talk at the same time and to navigate a Windows environment 

  • Reliable transportation with ability to travel frequently in assigned territory

  • Access to high speed internet service provider in your place of home office (Service will be maintained by Americhoice)

 
Additional Assets Preferred:
  • BSN

  • Milliman or Interqual criteria experience

  • Experience with Medicaid rules and regulations

  • A Background in managed care

  • Certified Case Manager (CCM)

  • Experience /exposure with discharge planning

  • Experience in utilization review, concurrent review and/or risk management

  • Strong organizational skills and multitasking abilities will be keys to success

 
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.
 


Additional Information:

  • Travel Percentage: 50%

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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.
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