RN Case Manager- Field – Atlantic and Cumberland Counties Position Available In Atlantic, New Jersey

RN Case Manager

• Field
• Atlantic and Cumberland Counties
• NJ

Requisition Number:

2287964

Job Category:

Nursing

Primary Location:

Atlantic City, NJ, US 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. The RN Case Manager will be the primary care manager for a panel of members with complex medical/behavioral needs. Care management activities will focus on supporting member’s medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. Expect to spend about 75% of your time in the field visiting our members in their homes or in long-term care facilities. You’ll need to be flexible, adaptable and, above all, patient in all types of situations. Do you live or are you willing to travel to any of the following counties? Atlantic and Cumberland Counties•

NJ Primary Responsibilities:

Perform initial and concurrent review of inpatient cases applying MCG criteria for approval and sending to Medical Directors if review is necessary for determining an adverse determination
Discuss cases with facility healthcare professionals to obtain plans-of-care
Collaborate with UnitedHealthcare Medical Directors on performing utilization management
Participation in discussions with the Clinical Services team to improve the progression of care to the most appropriate level
Consult with the Medical Director as needed for complex cases and make appropriate referrals to sister segments clinical expertise when discussing case with internal and external Case Managers and Physicians
Identify delays in care or services and manage with MD
Follow all Standard Operating Procedures in end-to-end management of cases
Obtain clinical information to assess and expedite alternate levels of care
Facilitate timely and appropriate care and effective discharge planning
Participate in team meetings, education discussions and related activities
Maintain compliance with Federal, State and accreditation organizations
Identify opportunities for improved communication or processes
Participate in telephonic and in-person staff meetings
Plan for MCG Certification 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:

Current, unrestricted RN license in New Jersey
3+ years of total experience, including recent clinical experience in an inpatient/acute setting
Experience in acute, long-term care, acute rehabilitation, or skilled nursing facilities
Experience performing discharge planning
Solid computer skills
Driver’s license and access to reliable transportation, ability to travel up to 75% within assigned territory to meet with members and provider

Preferred Qualifications:

Certification in Case Management or willingness to obtain 2+ years of case management experience
Experience in utilization review and/or utilization management Experience with MCG Guidelines or InterQual
Ability to work independently
Demonstrated effective verbal and written communication skills Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug

• free workplace.

Candidates are required to pass a drug test before beginning employment. Additional Job Detail Information Requisition Number
2287964 Business Segment
UnitedHealthcare Employee Status
Regular Job Level
Individual Contributor Travel
No Additional Locations Northfield, NJ, US Millville, NJ, US Vineland, NJ, US Overtime Status
Non-exempt Schedule
Full-time Shift
Day Job Telecommuter Position
No