The more health care changes, the more certain values count. Like quality, patient-centric care, compassion and a dedication to going the extra mile. As a RN Case Manager, you'll wear many hats and work in a variety of environments. But wherever you happen to find yourself, you’ll gain a profound sense of satisfaction knowing you’re helping to create a more efficient and effective health care system for everyone.
If you are located in Jacksonville, Miramar or Tampa, Florida, you will have the flexibility to telecommute* as you take on some tough challenges. This role involves approximately 25% travel with 80% telephonic and you’ll need to be comfortable dealing with a full range of in-home and facility-based environments. Most of the time you’ll work autonomously, so the ability to stay focused and motivated is essential.
- Execute prior authorization process for private duty nursing service requests
- Collaborate with treating physicians and other healthcare professionals to obtain data and information to support medical necessity review of private duty nursing service
- Consult with Medical Director as needed for complex cases
- Serve as a back –up coverage in providing resolution to escalated members’ issues
- Support to health plan programs, such as the Healthy Behaviors program
- Complete referrals to different programs to support members’ needs
- Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
- Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
- Undergraduate degree or equivalent experience
- Current, unrestricted RN license in FL
- Access to reliable transportation
- 4+ years clinical experience in prior authorization, hospital, acute care, home health/hospice, direct care or case management
- Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
- Utilization management experience &/Or Prior Authorization experience with Private Duty Nursing
- Home care/field based case management
- Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
- Bilingual skills
- Experience in working with FL Medicaid population
- Strong organization skills
- Skillful with prioritizing daily activities and deliverables
- Comfortable with working under time pressure
- Strong interpersonal and communication skills- both written and verbal
- Strong clinical Assessment skills and critical thinking skills
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place 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.
Job keywords: Registered Nurse, RN, Prior Authorization, Private Duty Nursing, case manager, case management, managed care, field-based, healthcare, health care, Jacksonville, FL, Miramar, Florida, Tampa, Telecommute