Company Description

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. If you are located within 30-50 miles of within Jacksonville, TX you will have the flexibility to work remotely* as you take on some tough challenges. Zip Code Areas: 75766; 75780; 75654; 75667; 75681 and 75643 This is a Field Based role with a Home-Based office.

Job Description

Requirements

Required Qualifications Current unrestricted RN license in the state of Texas 2+ years of experience working within the community health setting or in a healthcare role Familiarity with Microsoft Office, including Word, Excel, and Outlook Reliable transportation and the ability to travel in this ‘assigned region’ to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers' offices High-speed internet at residence Preferred Qualifications 1+ years of experience with long term care services and support, Medicaid or Medicare Ability to create, edit, save and send documents, spreadsheets and emails Knowledge of the principles of most integrated settings, including federal and State requirements like the federal home and community-based settings regulations Reside within commutable distance of assigned duties All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Responsibilities

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Utilize both company and community-based resources to establish a safe and effective case management plan for members Collaborate with patient, family, and healthcare providers to develop an individualized plan of care Identify and initiate referrals for social service programs; including financial, psychosocial, community, and state supportive services Manage care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team Utilize approved clinical criteria to assess and determine appropriate level of care for members Document all member assessments, care plan and referrals provided Participate in Interdisciplinary team meetings and Utilization Management rounds and provide information to assist with safe transitions of care Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan Accountable to understand role and how it affects utilization management benchmarks and quality outcomes Expect to spend about 75% of your time in the field visiting our members in their homes or in long - term care facilities. You’ll need to be flexible, adaptable and, above all, patient in all types of situations

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