Case Manager Registered Nurse

Employer: UnitedHealth Group

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Assist in the review of medical records to highlight Star opportunities for the medical staff.
• Activities include data collection, data entry, quality monitoring, upload of images, and chart collection activities.
• Locate medical screening results/documentation to ensure quality measures are followed in the closure of gaps. Will not conduct any evaluation or interpretation of Clinical data.
• Track appointments and document information completely and accurately in all currently supported systems in a timely manner.
• Optimize customer satisfaction, positively impact the closing of gaps in care and productivity.
• Partner with your leadership team, the practice administrative or clinical staff to determine the best strategies to support the practice and our members ensuring that recommended preventative health screenings are completed and HEDIS gaps in care are addressed
• Interaction with UHC members via telephone to assist and support an appropriate level of care. This may include making outbound calls to members and/or providers to assist in scheduling appointments, closing gaps in care or chart collection activities.
• Answer inbound calls from members and/or providers regarding appointments.
• Communicate scheduling challenges or trends that may negatively impact quality outcomes.
• Demonstrate sensitivity to issues and show proactive behavior in addressing customer needs.
• Provide ongoing support and education to team members and assist in removing barriers in care.
• Manage time effectively to ensure productivity goals are met.
• Ability to work independently in virtual setting. Ability to problem solve, use best professional judgment, and apply critical thinking techniques to resolve issues as they arise.
• Identify and seek out opportunities within one’s own workflow to improve call efficiency.
• Adhere to corporate requirements related to industry regulations/responsibilities.
• Maintain confidentiality and adhere to HIPAA requirements.
• Data analysis required for multiple system platforms to identify open quality opportunities to address on a member or provider level
• Appointment coordination for specialist appointments, late to refill medication outreach and scheduling members for local market clinic events
• Participate within department campaigns to improve overall quality improvements within measure star ratings or contracts.
• Field based activities require the abilities to support appropriate targeted providers.
• Other duties, as assigned

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:

• High School Diploma / GED (or higher)
• 2+ years of telephonic customer service experience
• 1+ years of a healthcare background with medical terminology familiarity of clinical issues
• 1+ years of working experience with ICD- 9/10 and CPT Codes
• 1+ years of working experience with / knowledge of HIPAA compliance requirements
• Experience with Microsoft Excel (navigating, filtering and analyzing reports)
• Data entry skills, with a typing speed of at least 45-50 WPM
• Ability to work Monday-Friday any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• 1+ years of STARs experience
• Medical/clinical background
• Knowledge of electronic medical record systems
• Consulting experience
• Knowledge of the Medicare market
• Knowledge base of clinical standards of care, preventive health, and Stars measures
• Experience in managed care working with network and provider relations/contracting
• Financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
• Microsoft Office specialist with exceptional analytical and data representation expertise – Microsoft Outlook (compose and respond to email) and Microsoft PowerPoint (create, edit, and format presentations)
• LPN or Medical Assistant

Soft Skills:

• Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities.
• Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect.
• Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s).
• Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
• Strong problem-solving skills
• Good Attendance Record

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

APPLY HERE