Telephonic Clinical Care Manager RN Remote in FL – Bilingual Spanish Preferred

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.

This position will be the primary care manager for a panel of members with primary complex medical needs. The Care Management / coordination activities will focus on supporting member’s medical, behavioral and socioeconomic needs to promote appropriate utilization of services and improved quality of care. All case management/ coordination activities will be in alignment with evidence-based guidelines. This position will liaison with the members’ provider community to help reduce fragmentation within the care ecosystem. The role will provide medically oriented clinical consults/guidance within the team and to other area within the health plan. The Clinical Care Manager will approach their member work with an understanding of how inequities drive health disparities. They will promote health equity. If you are located in Florida, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges.

Serve as primary care manager for members with primary complex medical needs Engage members through a variety of modalities (telephonically) to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, socioeconomic and SDOH needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, community resources/partners and leverage expertise to implement care plan Monitor and update care plan, incorporating feedback from member to monitor compliance with interventions to achieve care plan goals Provide education and coaching to support: Member self-management of care needs in alignment with evidence-based guidelines Lifestyle changes to promote health, i.e. smoking cessation, weight management, exercise Assist member in development of personal wellness plan / health crisis plan Perform targeted activities and provide education to support HEDIS/STAR gap closure, including scheduling, reminding and verification of appointment to receive specific services Monitor compliance with medication regimen and make referrals to Pharmacist for medication review and recommendations Reassess and update care plan with change in condition or care needs Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Access and Coordinate Medicaid Benefits to support care needs Document all care management/coordination activity in clinical care management record