Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work. (sm) *This position is M-F 8am-5pm and located at 13751 Metropolis Ave. Fort Myers, FL 33912* The Utilization Review RN is responsible for successfully supporting patients with high risk health conditions to navigate the healthcare system. The Healthcare Manager assists in developing patient empowerment by acting as an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. The Healthcare Manager interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, laboratory technologists, social workers, and other educators. The Healthcare Manager acts as a resource for clinic staff. The Healthcare Manager works in a less structured, self-directed environment and performs all nursing duties within the scope of a RN license of the applicable state board of nursing. Primary Responsibilities:Works with the providers and clinic staff to identify patients at high risk Supports longitudinal care of the patient with chronic care conditions by: Performing assessment of health conditions Performing medication reconciliation Conducting Motivational Interviewing and Self-Management Goal setting Providing patient education Creating referrals to appropriate agencies and resourcesSupports transition of the patient with chronic care conditions from inpatient to outpatient setting by: Performing assessment of transitional needs Performing medication reconciliation Establishing and reviewing contingency plan Providing patient education Assisting with post discharge needs such as prescriptions, transportation, Durable Medical Equipment (DME), appointmentsCoordinate with providers to establish or update plan of care Performs accurate and timely documentation in the electronic medical record Participates in daily huddles and Patient Care Coordination (PCC) meetings Prepares accurate and timely reports, as required, for weekly meetings Maintains continued competence in nursing practice and knowledge of current evidence based practices May perform clinical tasks within their scope of practice Performs all other related duties as assigned
Required Qualifications:Bachelor's degree in Nursing or Associate's degree in Nursing with four or more years of experienceRegistered Nurse with an active and unrestricted license to practice in FloridaCurrent BLS/CPR certification or ability to obtain upon hire 2+ years of experience in a physician's office, clinical or hospital setting Knowledge of chronic diseases, especially COPD/asthma, diabetes, CHF and IHD This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of diseasePreferred Qualifications:Experience with InterQual and Milliman Experience related to patient education and/or motivational interviewing skills and self management Goal setting Fluent written and verbal skills in English and SpanishIf the hired individual resides in Florida (office based or telecommuting) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.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. Job Keywords: RN, Inpatient, Milliman, Interqual, UM, UR, utilization review, utilization management, discharge planning
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.