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UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country. Primary responsibilities:
• Develop and maintain excellent performance and quality service for the ICCT Management team.
• Maintain a focus on the customer service through policy and program decisions and consider impact of these activities on the members.
• Facilitate interdepartmental communication as needed for integration purposes.
• Facilitate problem resolution with members, providers, and other agencies or entities as needed.
• Conduct initial and follow-up assessments within designated timeframes on patients identified as having complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial)
• Assess the patient's current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatment plan
• Engage patient, family, caregivers, and healthcare providers to assure that a well-coordinated treatment plan is established.
• Utilize holistic approaches to patient care and integrates patient's life and motivational goals into the treatment plan.
• Prioritize care needs, set goals and develop a treatment plan (or plan of care) that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation.
• Track the patient's health status and progress in achieving clinical and personal goals.
• Initiate PRN calls when key gaps are identified that require additional nursing follow-up.
• Provide education, information, direction, and support related to care goals of patients
• Coordinate acquisition and proper use of medical equipment, initially and on an ongoing basis
• Communicate with patients, families, caregivers, physicians, and other service providers to coordinate the care needs for the patient
• Work to facilitate patient compliance and to ensure continuity of care
• Making outbound calls to assess members' current health status
• Identifying gaps or barriers in treatment plans
• Providing patient education to assist with self management
• Interacting with Medical Directors on challenging cases
• Coordinating care for members
• Making referrals to outside sources
• Coordinating services as needed (home health, DME, etc)
• Educating members on disease processes
• Encouraging members to make healthy lifestyle changes
• Documenting and tracking findings
• Utilizing Milliman criteria to determine if patients are in the correct hospital setting
• Making 'welcome home' calls to ensure that discharged member receive the necessary services and resources
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.Qualifications:
• Clinical Registered Nurse with current licensure in the state of Louisiana required
• Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements preferred
• Reliable transportation and the ability to travel within an assigned territory as needed.
• 5+ years Clinical background required (experience in behavioral health, complex case, or community healthcare experience is preferred)
• Experience in case management preferred
• Proficiency in software applications that include, but are not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint
• Demonstrated ability to assist with focusing activities toward a strategic direction as well as develop tactical plans, drive performance and achieve targets
• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. Additional assets preferred:
• Bilingual a plus
• Bachelors degree in Science or equivalent work experience required; Masters degree preferred
• Medicare and/or Medicaid experience
• FQHC
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
-------------------------------------------------------------------------------------------------------------------------------------------------------- ONLY WAY TO APPLY FOR POSSIBLE CONSIDERATION IS BY GOING TO http://careers.unitedhealthgroup.com AND SEARCH FOR JOB #372123
RESUMES SUBMITTED VIA THIS EMAIL WILL NOT BE ABLE TO BE PROCESSED AS QUICKLY AS YOU APPLYING DIRECTLY TO THE POSITION ON OUR WEBSITE. BECOME A POTENTIAL QUALIFIED CANDIDATE QUICKIER BY APPLYING AT http://careers.unitedhealthgroup.com Location: New Orleans
Compensation: Competitive
Principals only. Recruiters, please don't contact this job poster.
Please, no phone calls about this job!
Please do not contact job poster about other services, products or commercial interests.

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Published at 01-27-2012
Viewed: 11 times