Escalation Review Nurse RN at UnitedHealth Group

About the position
For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. You push yourself to reach higher and go further. Because for you, it's all about ensuring a positive outcome for patients. In this role, you'll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you'll have the support of an elite and dynamic team. Join UnitedHealth Group and our family of businesses and you will use your diverse knowledge and experience to make health care work better for our patients. The United Healthcare at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The DSNP program combines clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the clinician, the member's Primary Care Provider and other providers, and other professionals. If you are located in the District of Columbia, you will have the flexibility to telecommute as you take on some tough challenges. This role is a telephonic role with expectation of at least quarterly in person staff meetings. You'll need to be flexible, adaptable and, above all, patient in all types of situations. Core Position Hours: Monday - Friday, 8:00am - 5:00pm.
Responsibilities
? Assess, plan and implement care management interventions that are individualized for each patient and directed toward the most appropriate, least restrictive level of care
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? Assist and address member escalations coming from DHCF officials, hospital systems, DC agencies, members, families, caregivers or others
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? Address and triage Care Management and Utilization Management issues in partnership with the member's assigned Care Manager and Market Leadership
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? Identify and initiate referrals for both healthcare and community-based services; including but not limited to financial, psychosocial, community and state supportive services
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? Develop and implement care plan interventions throughout the continuum of care as a single point of contact
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? Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
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? Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
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? Identify appropriate interventions and resources to meet gaps (e. g., psychosocial, transportation, long-term care) based on specific consumer needs from both the health care and psychosocial / socioeconomic dimensions of care
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? Document the plan of care in appropriate EHR systems and enter data per specified
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? Maintain consumer engagement by establishing rapport, demonstrating empathy, and building a trusting relationship
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? Collaborate with primary providers or multidisciplinary team to align or integrate goals to plan of care and drive consistent coordination of care
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? Provide ongoing support for advanced care planning
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? Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals
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? Understand and operate effectively/efficiently within legal/regulatory requirements
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? Utilize evidence-based guidelines (e. g., medical necessity guidelines, practice standard)
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? Make outbound calls and receive inbound calls to assess members' current health status
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? Identify gaps or barriers in treatment plans
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? Provide patient education to assist with self-management
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? Make referrals to outside sources
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? Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
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? Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
Requirements
? Active, unrestricted Registered Nurse (RN) license
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? 1+ years of experience working within the community health setting in a health care facility
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? 1+ years of experience providing community-based care management to members receiving long-term care, personal care services, private duty nursing, or home health
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? Demonstrated competency working with Enrollees and/or families who require intensive case management services
Nice-to-haves
? Certified Case Manager (CCM) certification
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? Experience in managing populations with complex medical or behavioral needs
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? Experience working with Home Care Based Services and/or patients in community and home-based settings
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? Experience with case management, utilization review, discharge planning, concurrent review and/or risk management
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? Field-based work experience
Benefits
? Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
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? Medical Plan options along with participation in a Health Spending Account or a Health Saving account
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? Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
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? 401(k) Savings Plan, Employee Stock Purchase Plan
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? Education Reimbursement
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? Employee Discounts
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? Employee Assistance Program
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? Employee Referral Bonus Program
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? Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)