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RN Case Manager- Field - Chicago, IL - Case Management

Company: UnitedHealth Group Inc
Location: Skokie
Posted on: May 12, 2024

Job Description:

RN Case Manager- Field - Chicago, IL
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere.

As a team member of our Senior Community Care (SCC) product, we work with a team to provide care to patients at home in a nursing home, assisted living for senior housing. This life-changing work adds a layer of support to improve access to care.

We're connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.

An RN functions as part of the primary care team and reports to the Clinical Services Manager (CSM). The RN performs activities that fall within the RN scope of practice. This role works in close collaboration with all of the team members and may support multiple providers. The RN works under the direction of the provider, and activities are delegated to the RN by the provider or the team CSM. The RN understands and supports the CPM models of care Institutional Special Needs Plan (ISNP), Institutional Equivalent Special Needs Plan (IESNP) and Transitions to Skilled (TTS) and works in collaboration with the team to meet the goals of the program. RN may be required to provide on-site clinical support to patients or facilities. you will work in the field in the area a significant amount of time.

Fieldwork location: Arlington Heights/Des Plaines, IL, with an approximate 45-minute radius travel to partner facilities

Primary Responsibilities:

* Care Coordination
* Assist the provider/team with various care coordination activities in the nursing home and/or assisted living community (AL)
* RN works in collaboration with the nursing facilities/AL community to assist in coordinating transportation when appropriate


* Benefit Determination
* Assist the provider/team with benefit determination associated with Medicare part A, part B, and part D benefits
* The RN is responsible for collaborating with the nursing facility/AL to identify and respond to patient change in condition
* RN may assist the provider by completing DSTs, re-assessing the patient, and other activities to support BD, as delegated by the provider or the CSM


* Therapy Coordination
* Assist the provider/team with therapy coordination for patients including possible assessments or follow up on requests and communicate/collaborate with NP
* The RN may perform interval check in on patient progress with therapy department
* The RN may participate in facility-based therapy discussion meetings


* Team Support
* Schedule and participate in family conferences, team meetings, and team case presentations
* Assist in the coordination of N95 fit testing, CPR training/recertification, tracking compliance with infection control measures, tracking TAP data etc.
* Participate in the onboarding of new clinical staff under the direction of the CSM- the RN may coordinate onboarding activities, and participate in other orientation activities under the direction of the CSMs or DCOs
* Participate in facility partnership or Customer Relationship Management (CRM) meetings under the direction of the NP/CSM- the RN may assist in coordinating CRM meetings, and may participate in and contribute to the meetings
* The RN may assist the team in tracking LearnSource completion for the team members and CSM


* In-servicing
* Assist in creating and conduct in-services for selected audiences


* Documentation
* Will document information and activities in the EMR
* RN may assist Providers in assuring complete and accurate coding


* Advanced Care Planning
* Assist the team/providers in prioritizing advance Care Planning and initiating discussions


* Communication
* Collaborates with all key stakeholders; providers, nursing homes/assisted living facilities, PCPs, families, interdisciplinary care teams and any other identified stakeholders
* Support of contracted providers
* May support contracted providers with above activities and other selected duties in appropriate markets Quality/HEDIS


* Quality/HEDIS
* The RN will review the chart and enter HEDIS/Quality information into the EMR
* The RN may identify gaps in the HEDIS/Quality measures and communicate these to the NP for resolution. i.e. missing vaccinations, lab work etc.
* The RN may assist with managing the annual flu vaccine initiative; communicate with families, nursing staff, identify gaps
* The RN may do the Medication Reconciliation post hospital, skilled event, or ER visit


* Patient Care
* Patient assessment for Change in Condition - RN may perform a nursing assessment on a patient within scope of practice, communicate findings back to NP
* The RN may make rounds and identify high risk patients
* RN may be required to provide on-site support to patients or facilities
* The RN may gather information for rounds and enter into preliminary note as described in the documentation section
* The RN may write verbal orders from Provider in the chart in compliance with the state RN practice laws, and in compliance with individual nursing facility practices



What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

* Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
* Medical Plan options along with participation in a Health Spending Account or a Health Saving account
* Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
* 401(k) Savings Plan, Employee Stock Purchase Plan
* Education Reimbursement
* Employee Discounts
* Employee Assistance Program
* Employee Referral Bonus Program
* Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
* More information can be downloaded at:

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 Registered Nurse license in the state of practice
* 3+ years of experience in post- acute care, such as long-term care or hospice and/or Case Management experience as an RN
* 3+ years of experience conducting assessments and/or evaluations
* Valid driver's license with appropriate insurance
* Field base-travel 80%

Preferred Qualifications:

* Bachelor's degree
* Experience working with the geriatric population
* Experience with using an Electronic Medical Record
* Familiarity with the long-term care business environment
* Proven basic Microsoft Office skills with the ability to navigate in a Window's environment
* Proven excellent communication and customer service skills



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.

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.

Keywords: UnitedHealth Group Inc, Skokie , RN Case Manager- Field - Chicago, IL - Case Management, Executive , Skokie, Illinois

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