RN - Complex Case Manager Nurse - Prohealth Physicians

Unitedhealth Group Inc. Farmington , CT 06030

Posted 2 months ago

  • $1,000 sign on bonus for all external hires

If you want to get way ahead in your career, it makes sense to be with an organization's that's way ahead of the curve. Formed in 1997, ProHealth Physicians, part of OptumCare, has grown to become Connecticut's leading primary care physician organization. With over 90 locations throughout the state of Connecticut, our family of primary care doctors and specialists care for more than 360,000 people statewide. In fact, ProHealth serves every county and provides roughly ten percent of the primary care delivered to patients in the state. We're leaders in thinking and in serving our communities. For instance, we're a C.M.S. approved Accountable Care Organization (ACO), covering over 30,000 Medicare patients associated with our community-based primary care providers. We're also nationally recognized as a NCQA Level III Medical Home. That kind of progressive leadership makes us perfect fit for OptumCare and UnitedHealth Group's expanding family of providers. This is a place where you can stay way ahead as you do your life's best work.(sm)

ProHealth Physicians (OptumCare Co) has an immediate opening for a Nurse - RN, Complex Case Manager. Under general administrative direction, coordinate referrals from physicians and health care facilities for Members; provides a significant level of Member education related to their illness and planned treatment.

Primary Responsibilities:

  • Member Care Coordination. Works closely with physicians involved in member's plan of care to coordinate care plan communication; works with multidisciplinary team to maintain and implement up-to-date coordinated care plan; communicates with all members of the healthcare team on behalf of the Member

  • Member Referral Support: Assists physician providers, Members and their families in obtaining referrals to needed specialists. Provides support and counseling, as appropriate to the clinical situation

  • Care Plan Development. Works with designated physicians to develop and maintain Member Care Plans

  • Clinical Improvement. Proactively participates in the development and deployment of Coordination of Care activities with the goal of improving the clinical experience for referred Members and the referring physician.

  • Liaison. Communicates with members of the Care Team as appropriate to coordinate the identified Member and physician's needs

  • Provider/Member Education. Educate Member and care team participants on community/health plan benefit services available.

  • As Needed. Performs various duties as needed to successfully fulfill the function of the position in conjunction with Medical Management

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • Bachelor's Degree in Nursing (BSN) (or four years managed care experience in lieu of a BSN)

  • Unrestricted current CT Nursing License

  • One year experience as a nurse case manager

  • One year experience managing complex disease states

  • Ability to travel up to Farmington CT for training and meetings as needed. Possible travel to other locations at times. Position will be approx. 80% remote based.

  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role

  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

  • Experience with Electronic Health Records

  • Certified Case Manager

  • Home care or hospice case management experience

  • Three years experience as a nurse case manager

  • Three years experience managing complex disease states

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)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

For more information on our Internal Job Posting Policy, click here.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

Job Keywords: RN Case Manager, Farmington, CT, Connecticut

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