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Nurse Case Manager Providence, RI - 2200014

Genoa Telepsychiatry

Genoa Telepsychiatry

Providence, RI, USA
Posted on Saturday, November 18, 2023

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. 

The Nurse Case Manager (NCM) supports the primary visiting provider (PVP) in assessing and managing the overall patient care management process.  In addition, the Nurse Case Manager will identify and collaborate on innovative actions to meet the needs of OPTUM patients from both the health care and psychosocial / socioeconomic dimensions of care; as well as taking action for provision of services to meet the patient needs. The NCM provides oversight, guidance and support for the patient care plan as developed in collaboration with the PVP. This care plan is based on the comprehensive history & physical completed by the PVP and the nursing assessment. The NCM uses both assessments and ongoing telephonic assessments to help guide treatment and care decisions of the team with a focus on trigger management to prevent adverse outcomes.  In addition the NCM collaborates with the health plan and additional heath care vendors to meet the needs of the patient and also identifies services and vendors for needed care while navigating patient benefit plans. 

The Nurse Case Manager will ensure that all pertinent documentation is in the medical record in a manner compliant with CMS, OPTUM and client requirements.  

Primary Responsibilities: 

  • Conduct initial and ongoing assessments utilizing nursing assessment skills 
  • Develop and implement an effective care plan to meet the needs of OPTUM community patients from both the health care and psychosocial / socioeconomic dimensions of care
  • Advocate for the patient in all activities including nursing assessments, care coordination, care plan development, and communication. 
  • Identify triggers for hospitalization and develop (in collaboration with members of the care team) an effective care plan
  • Communicate and collaborate with other members of the health care team (PCP, PVP, CMA, health plan) to coordinate all needed care and service
  • Provide ongoing patient education leveraging written material as available/approved by the health plan
  • Provide ongoing support of patients with advance care planning
  • Provide 24/7 support for the PVPs as needed

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: 

  • Active unrestricted RN state license 
  • 5+ years of nursing experience
  • Experience working in a skilled nursing or hospital setting 
  • Experience working within a team environment
  • Proven excellent organizational skills with the ability to multi-task
  • Proven ability to travel to various skilled nursing facilities within a thirty mile radius

Preferred Qualifications:

  • Case Management certification
  • IV certification 
  • Case management experience
  • Managed care, utilization management, risk management, quality management, case management experience
  • Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial
  • Familiarity with ICD-9 and CPT-4 coding
  • Bi-lingual or multi-lingual
  • Proven excellent organizational skills with the ability to multi-task

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.