At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone
LHI is one of 4 businesses under OptumServe. OptumServeprovides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.
LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on-location services, patient-specific in-clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doingyour life's best work.(sm)
We are currently seeking an RN Specialty Case Manager - Oncology to join our team in Lacrosse, WI. This individual will be responsible for assessing and coordinating care for a very diverse population of members of the World Trade Center Nationwide Provider Network. Educate and inform members of program coverage and limitations while ensuring that high quality and cost-effective care is provided within contract requirements. Use critical thinking and problem solving skills to navigate through the complexities of a members health conditions while maintaining coverage within the program guidelines. Coordinate health care services for members. Prepare and summarize medical history information on members to present to the Medical Director. Cultivate relationships with members, providers, co-workers, and other team members to ensure program compliance and member satisfaction. This specialty role will be a primary point of contact for those members with a cancer diagnosis. The expectation is to integrate their technical skills, scientific knowledge, and caring attitude to aid those living with cancer, including their families - starting from diagnosis, treatment, to end of life care.
Maintain ongoing responsibility for caseload which entails assessment, education and coordination of care
Monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner, and facilitate changes as needed
Identify gaps or barriers in treatment to promote member health and wellness and member satisfaction
Educate members on cancer - related issues to provide treatment knowledge and advocacy
Increase and maintain cancer knowledge to enhance treatment protocols assigned to cancer patients
Keep team members up to date on cancer industry standards
Acknowledge patients rights on confidentiality issues, maintains patient confidentiality at all times, and follows HIPAA guidelines and regulations
Review medical records to determine WTC relatedness for potential program coverage and communicate results of the review to members
Communicate with providers to prior authorize tests and procedures related to a members certified condition as it relates to program coverage
Watch and record the patients progress on a consistent basis
Interact with Medical Director on challenging cases to effectively resolve issues
Act as a subject matter expert in Cancer
Ensure continuity of Care Planning
Please Note: In order to be considered for this position, you must be able to obtain an SF86 Position of Trust which is only available to U.S. Citizens. Our Facilities Security Officer will initiate this process post-offer acceptance. Failure to obtain this will result in termination from this role.
Associate or Bachelors degree in Nursing
Current license or ability to obtain license in the state of WI or compact state
Minimum of 4 years of clinical experience
Proficient computer skills
Ability to work independently as well as on a team
Excellent verbal and written communication skills including strong telephone etiquette and interpersonal skills with individuals at all levels of an organization
Demonstrated ability to adapt to performing a variety of duties, changing from one task to another of a different nature, without loss of efficiency or composure
Must be able to implement critical thinking and decision making skills in order to identify appropriate care / treatment plans for a wide range of members from low to high complexity
Must have the ability to take initiative and be detail - oriented in a goal - oriented environment
United States Citizenship
Ability to obtain favorable adjudication following submission of Defense Health Agency eQuip Form SF86
RN Oncology experience
Case Management experience, behavioral health, occupational health or medical / surgical background
Previous military healthcare experience
Medical call center experience or medical related experience in a corporate / business setting
Knowledge of ICD and CPT coding
URAC / ISO experience / knowledge
National Career Readiness Certificate
UnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/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.