RN Case Manager, Private Duty Nursing - Remote in Kentucky

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.

As a RN Case Manager, you will act in a clinical liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The RN works in a team-based structure and spends 25% of their time in the community engaging directly with members. You will work with medically complex patients who may be experiencing significant addiction and/or behavioral health conditions is important for this role. This is high volume, customer centric environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone and in person. Solid computer and software navigation skills are critical. If you reside in the state of Kentucky, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges.

Making outbound calls to assess members’ current health status Manage a caseload of highly complex members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), Pediatric Extended Care Facilities, Private Duty Nursing Organizations, behavioral health providers, Primary Care Physicians, etc. Solves moderately complex problems and/or conducts moderately complex analyses Performing and coordinating management of Single case agreements Coordinating authorization of eligibility of Private Duty Nursing contracts for medically complex members Coordinating authorizations for eligible members with pediatric Extended Care facilities for medically complex pediatric members Consult with care team to address specialty care services, community-based resources, and other member complex care needs Working towards fulfilling medically complex member care needs Identifying gaps or barriers in treatment plans Providing member and care giver with education to assist with management of medically complex needs of member Interacting with Medical Directors, providers, internal and external partners on challenging cases Coordinating care for high risk, medically complex members Making referrals and connecting members to community resources Coordinating services as needed (home health, DME, etc.) Educating member and care giver on disease processes Performing periodic reviews of cases to determine continued eligibility of services Documenting and tracking findings