RN Field Case Manager, Maternal Health - Remote in Louisville, KY
At UnitedHealthcare, were 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.
As a Maternal Health RN, you will act in a clinical liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The RN works in a team-based structure and spends 25% of their time in the community engaging directly with members. You will work with medically complex patients who may be experiencing significant addiction and/or behavioral health conditions is important for this role.
This is high volume, customer centric environment. Youll need to be efficient, productive and thorough dealing with our members over the phone and in person. Solid computer and software navigation skills are critical.
If you reside in or within commutable driving distance to Louisville, KY, youll enjoy the flexibility to work remotely * as you take on some tough challenges.
Primary Responsibilities:
Making outbound calls to assess members' current health status
Manage highly complex members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), OB providers, behavioral health providers, etc.
Consult with care team to address specialty care services, community-based resources, and other member complex care needs
Assist in identification of pregnant women and children including those with special health care needs and access/linkages to appropriate care
Working with the complex maternity care needs
Identifying gaps or barriers in treatment plans
Providing patient education to assist with self-management
Interacting with Medical Directors, providers, internal and external partners on challenging cases
Coordinating care for high risk maternity members
Making referrals and connecting members to community resources
Coordinating services as needed (home health, DME, etc.)
Educating members on disease processes
Educating members on (e.g. inter-conception care, chronic condition management, smoking cessation, safe sleep for infants, breast feeding advantages, substance use avoidance, etc.)
Encouraging members to make healthy lifestyle changes
Documenting and tracking findings
Youll 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 the State of Kentucky
3 years of experience in a hospital setting, acute care, direct care experience as an RN and / or experience as a telephonic Case Manager for an insurance company
2 years of High-Risk OB clinical nursing experience plus current / prior position as a Case Manager OR 3 years of High-Risk OB clinical nursing experience
Proficiency with Microsoft Office Suite, with the ability to navigate a Windows environment
Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, Internet research, use of online calendars and other software applications
Live in or within commutable driving distance to Louisville, KY
Access to reliable transportation and the ability to travel up to 25% within assigned region to visit Medicaid members in their homes and / or other settings, including community centers, hospitals or providers' offices
Must be able to attend one week of onsite training in Louisville, KY office (travel accommodations provided)
Preferred Qualifications:
BSN or health care related degree
Certified Case Manager (CCM)
A background in managed care
Experience in pediatrics or NICU
Medicaid experience
Case Management experience
Experience working with chronic illness and complex care needs population
Experience in utilization review, concurrent review and / or risk management
Experience with HIV population
Psychiatric or Behavioral Health experience
Bilingual Spanish speaking
Proven excellent Communication and Writing skills
Proven problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Proven ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves 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.
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.
Apply Now
As a Maternal Health RN, you will act in a clinical liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The RN works in a team-based structure and spends 25% of their time in the community engaging directly with members. You will work with medically complex patients who may be experiencing significant addiction and/or behavioral health conditions is important for this role.
This is high volume, customer centric environment. Youll need to be efficient, productive and thorough dealing with our members over the phone and in person. Solid computer and software navigation skills are critical.
If you reside in or within commutable driving distance to Louisville, KY, youll enjoy the flexibility to work remotely * as you take on some tough challenges.
Primary Responsibilities:
Making outbound calls to assess members' current health status
Manage highly complex members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), OB providers, behavioral health providers, etc.
Consult with care team to address specialty care services, community-based resources, and other member complex care needs
Assist in identification of pregnant women and children including those with special health care needs and access/linkages to appropriate care
Working with the complex maternity care needs
Identifying gaps or barriers in treatment plans
Providing patient education to assist with self-management
Interacting with Medical Directors, providers, internal and external partners on challenging cases
Coordinating care for high risk maternity members
Making referrals and connecting members to community resources
Coordinating services as needed (home health, DME, etc.)
Educating members on disease processes
Educating members on (e.g. inter-conception care, chronic condition management, smoking cessation, safe sleep for infants, breast feeding advantages, substance use avoidance, etc.)
Encouraging members to make healthy lifestyle changes
Documenting and tracking findings
Youll 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 the State of Kentucky
3 years of experience in a hospital setting, acute care, direct care experience as an RN and / or experience as a telephonic Case Manager for an insurance company
2 years of High-Risk OB clinical nursing experience plus current / prior position as a Case Manager OR 3 years of High-Risk OB clinical nursing experience
Proficiency with Microsoft Office Suite, with the ability to navigate a Windows environment
Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, Internet research, use of online calendars and other software applications
Live in or within commutable driving distance to Louisville, KY
Access to reliable transportation and the ability to travel up to 25% within assigned region to visit Medicaid members in their homes and / or other settings, including community centers, hospitals or providers' offices
Must be able to attend one week of onsite training in Louisville, KY office (travel accommodations provided)
Preferred Qualifications:
BSN or health care related degree
Certified Case Manager (CCM)
A background in managed care
Experience in pediatrics or NICU
Medicaid experience
Case Management experience
Experience working with chronic illness and complex care needs population
Experience in utilization review, concurrent review and / or risk management
Experience with HIV population
Psychiatric or Behavioral Health experience
Bilingual Spanish speaking
Proven excellent Communication and Writing skills
Proven problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Proven ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves 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.
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.
Apply Now