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LTC Nurse Care Manager, ALTCS - Remote in Arizona - 2225402

Genoa Telepsychiatry

Genoa Telepsychiatry

Customer Service
Tucson, AZ, USA · Phoenix, AZ, USA
Posted on Thursday, June 6, 2024

For more information about this role and others, please join us for a virtual hiring information session with Jean Kalbacher, Health Plan CEO and Francine Pechnik, Executive Director, our recruiters, benefit specialists and other health plan staff, to learn more about our organization, roles available and next steps.

The virtual event is Tuesday, June 4th, at 12:00pm AZ Time

To register for the event, please visit: https://uhg.hr/C&SArizonaInformationSession1

To view available roles and apply visit: https://uhg.hr/C&SArizonaOpenRoles

Roles available include Field Care Coordinator, Clinical Coordinator, Clinical Quality LPN, Clinical Quality RN, and other supporting roles.

At UnitedHealthcare, we’re 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.

UnitedHealth Group of Arizona is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every member they serve. UnitedHealth Group of Arizona’s focus is to do the right things for members, physicians, and the community. UnitedHealth Group of Arizona’s Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their members. The current focus of UnitedHealth Group of Arizona is on members in the Medicare population and those members with complex care needs, who most benefit from a high touch model of care.

Our LTC Nurse Care Managers are RN/LPNs who are responsible for the clinical coordination of care for members determined by medical need (Disease Management or High Cost High Needs) to necessitate care coordination, education, and clinical management for their complex needs. The LTC Nurse Care Managers goal is to help the member reduce hospitalization and emergency visits while maintaining quality of life in the lowest applicable treatment setting.

The LTC Nurse Care Manager coordinates members care for short episodic durations to help coordinate member health care complexity within their home. They link the member and care givers with the network of care team members to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence. LTC Care Manager is responsible for care management activities across the continuum of care including coordination of care, assisting Case Managers, providing health education, and providing coaching and treatment decision support for members. The LTC Care Manager participates in interdisciplinary conferences to given input to clinical assessments, assist to create care plans and determine follow-up frequency with the care coordination team.

This is a full time, Monday-Friday position. The RN must be able to communicate with members, health care representatives, providers, and family to evaluate and help educate to support the member’s medical needs. Applicants must be willing to carry a diverse clinical caseload and contact members telephonically in their home.

If you are located in Arizona, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

  • Collaborates effectively with interdisciplinary team (IDT) to assist in establishing an individualized plan of care for members, goals including both short and long term. May participates in IDT meetings
  • Works with the Utilization Management (UM) RNs, Social Worker (LMSWs) Case Managers and other internal and external providers to facilitate smooth care transitions
  • Stratifies and / or validates member level of risk and communicates during transition process with IDT
  • Ensures standardized execution of workflow processes, such as increase in admissions, monthly audits, and referral to Social Workers (LMSWs) or internal programs
  • Performs member specific telephonic evaluations and provides feedback on planned interventions and outcomes for the plan of care
  • Assists to coordinate PCP and specialists
  • Documents findings and assists in development of individualized care plans in a concise/comprehensive manner compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • Advocates for members and families as needed to ensure the member’s needs and choices are fully represented and supported by the health care team
  • Collaborates with providers to determine acuity of behavioral health concerns and refer members to appropriate community resources
  • Integrates a collaborative approach by attending interdisciplinary team meetings with nurses, physicians and pharmacy team regarding member care
  • Utilizes professional knowledge and critical thinking skills to facilitate MD consultation on complex and/or complicated cases
  • Nurse Case Managers work with their supervisor to work their assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process
  • Monitors and evaluates program interventions to demonstrate improvement in member outcomes within the HQUM committee meeting on a regular basis
  • Applies Nursing/Counseling/Social Work theory, knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function
  • Performs all other related duties as assigned

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 RN/LPN license in the state of AZ
  • 3+ years of clinical experience working with the adult and/or geriatric population
  • Experience working with Medicaid and Medicare
  • Experience using Care Management practice guidelines
  • Experience with Microsoft Office applications including Word and Excel
  • Knowledge of discharge planning alternatives options and interdisciplinary approaches
  • Proven ability to handle sensitive issues with members and providers in a confidential manner according to HIPAA guidelines

Preferred Qualifications:

  • CCM certification or obtained within 2 years of hire
  • 2+ years of care management experience
  • Experience working with individuals with multiple co-morbidities and complex medical conditions
  • Experience working with low-income populations, aged, blind or disabled
  • Clinical training experience
  • Medical/Behavioral setting experience (i.e. hospital, managed care organization, or joint medical/behavioral out member practice)
  • Dual diagnosis experience with mental health and substance abuse
  • Disease Management, High Need High Risk Care Management and/or Nurse Educator
  • Experience with Excel and Power Point
  • Bilingual (English / Spanish) language proficiency
  • Proven planning, organizing, conflict resolution, negotiating and interpersonal skills
  • Proven independent problem identification / resolution and decision making skills
  • Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously

UnitedHealth Group of Arizona are patient-centered groups working to support health plans with a top network of medical clinicians and hospitals that offer comprehensive care. We give patients the tools and resources to maintain their health and enjoy the activities that they love. We also offer transition programs that support patients leaving the hospital or skilled nursing facility and care Management programs that help patients with complex health problems get care in the comfort of their own homes.

UnitedHealth Group is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, UnitedHealth Group provides administrative and business support services to both owned and affiliated medical practices which are part of UnitedHealth Group Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. UnitedHealth Group support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.