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Medicare RN Case Manager - Telecommute in the Sebring, FL area

Job Location:
Sebring, FL
Metro Area:
FL - Tampa
Company Name: UnitedHealth Group
Website:  Click to Visit
UnitedHealth Group
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. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm) What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. This is a telecommute position inclusive of traveling to physician practices. Nurse Case Managers review charts (paper and electronic - EMR), close gaps in care, promote provider engagement, perform assessments, assist coordination of doctor appointments, make follow-up calls to members after appointments, assist members in overall wellness and prevention and drive STARS ratings with provider practices through practice education and quality measure monitoring. Case managers work at or with physician practices and or members on a daily basis. This position will be a work at home position with travel within Highland and Hardee County areas. Monday-Friday, days with50% - 75% travel. Primary Responsibilities: Function independently, travel across assigned territory to meet with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members May interact with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed Partner with the practice's administrative and clinical staff while managing patient appointments and data between visits Maintains the confidentiality of all sensitive information Establishes positive, long-term, consultative relationships with physicians, medical groups Provides ongoing strategic recommendations, training and coaching to provider groups on program implementation and barrier resolution Training to providers includes STARS measures (HEDIS/CAHPS/HOS/med adherence), and Optum program administration, use of plan tools, reports and systems Coordinates and leads Stars-specific meetings with provider groups with regular frequency to drive continual process improvement and achieve goals Provides suggestions and feedback to PPT leadership and health plan Collaborates with PPT team Includes up to 50 - 75% local travel and/or alternate assignment location as warranted Provide reporting to health plan via PPT leadership on progress of overall performance, gap closure, and use of virtual administrative resource Work collaboratively with PPT Leadership to keep providers aware of Plan-sponsored initiatives designed to assist and empower members in closing gaps


Required Qualifications: 3+ years of experience as a Registered Nurse RN with current, unrestricted license in state Previous experience working with Primary Care Physicians Computer proficiency/ to enter/retrieve data in electronic clinical records; proficiency with MS Office Must be able to travel to provider offices within service area Preferred Qualifications: Certified Coder, RHIT or RHIA Previous exposure to HEDIS / STARS Experience with EMR (electronic medical records) ICD-10 coding knowledge Medicaid, Medicare or Managed Care experience Prior Physician Office experience Case management experience, CCM preferred Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs Call Center experience Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal EmploymentOpportunity / 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. Job Keywords: Registered Nurse, RN, Case Manager, CCM, RHIT, HEDIS / STARS, Sebring, Florida, FL
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