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RN Case Manager - Philadelphia / Allentown, Pennsylvania

Expired Job

Unitedhealth Group Inc. Philadelphia , PA 19107

Posted 2 months ago

Responsible for managing the medical care received by a claimant following an injury. The RN Case Manager monitors all treatment and acts as a liaison between the account, provider, and the claimant for returning the claimant to health and/or work in an appropriate amount of time based on disability guidelines and physician assessment) and is responsible to coordinate care with quality and cost effective outcomes.

The RN Case Manager will be work out of their home office and will travel frequently to and from appointments, within a 2-hour radius, across the Philadelphia/Allentown area for Field Based Case Management. Responsibilities will also include Medical Bill Auditing.

Primary Responsibilities:

  • Implements and acknowledges all new referral contacts to account, claimant and physician within same business day

  • Monitors all treatment and acts as a liaison between the account, provider, and the claimant

  • Arranges and attends all medical evaluations, physician appointments and physical therapy when needed, including those that may occur before and after regular business hours, or on occasional weekends, and holidays in the event of catastrophic cases

  • Cases are assigned with geographic location taken into consideration, but territory may extend beyond a given location and cross state lines in some instances, depending upon need

  • Participates in coverage as needed for other team members and co-workers as able/requested by supervisor

  • Coordinates Independent Medical Examinations, as well as provider appointments

  • Participates in coordination of services for catastrophic cases to include, but not limited to, immediate visitation at Hospital to secure all accident and treatment information, coordination of discharge and home care needs

  • Arranges transportation services when necessary and authorized

  • Reviews and evaluates all medical correspondence obtained from providers

  • Coordinates and monitors home health care as necessary

  • Implements and utilizes community resources when applicable

  • Coordinates case management reviews with the Case Management Supervisor on all files

  • Provides medical testimony as required

  • Holds to the philosophy and standards of quality as outlined by Optum Management Inc

  • Contacts accounts for directives and provides updates on file status. Completes written correspondence completed after each visit or every 30 days according to account profile

  • Inputs service notes on all tasks utilizing the RMS system

  • Prepares all letters and reports and emails to office for formatting and mailing

  • Updates accounts via emails and phone

  • Secures ongoing medical records and handles as confidential information

  • Completes job descriptions; observes job site and completes job analyses

  • Compares and coordinates medical costs; analyses benefit outcomes and documents savings

  • Ensures confidentiality and maintains accurate record keeping

  • Maintains all educational requirements to renew and maintain licensure and certification

  • Maintains professional education in the area of rehabilitation and case management as well as current medical trends

  • Coordinates and attends all scheduled team meetings with all providers when necessary

  • Utilizes effective oral, written and organization skills and demonstrates the ability to prioritize case activities

  • Utilizes personal vehicle to travel to job sites, claimant homes, attorney offices and medical facilities as necessary to perform visits

  • Performs other case management duties as required

  • Coordinates specialty services as authorized and needed by the account

  • Maintains the highest level of customer / client confidentiality and customer service

  • Medical Bill Auditing to include but not limited to the following:

  • Completes preliminary review of file to assure that all records are present

  • Completes audit of itemized bill to assure that all charges are documented, related and medically necessary

  • Where applicable completes trauma review to assure that trauma classification applies

  • Reports findings in the audit report

  • Completes audits within State specified timeframes

Required Qualifications:

  • A current, unrestricted RN license in Pennsylvania

  • 3 years nursing case management experience

  • Two years or more years of full-time equivalent experience providing direct clinical care to the consumer

  • Must have access to reliable transportation that will enable you to visit customer or patient sites within a 2 hour radius of the designated area

  • Previous Worker's Compensation Case Management experience

  • Proficient computer skills including typing and Microsoft Office software

Preferred Qualifications:

  • CCM certification

  • Previous experience working with managed care

  • Experience with disability claims

  • Experience doing Medical Bill Auditing

  • New York RN license a plus

  • Bachelor's Degree or higher

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

  • All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.


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RN Case Manager - Philadelphia / Allentown, Pennsylvania

Expired Job

Unitedhealth Group Inc.