Position Description:Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.Positions are responsible for providing clinical and medical management services, including case management, health assessments, interventions, and discharge planning. May identify, coordinate or provide appropriate levels of care under the direct supervision of an RN or MD. This function does not include Health Coach, Health Educator and Health Advocate roles that do not require an RN. Those roles are found in the Wellness Coach Management function.Primary Responsibilities: Engage members either face to face or over the phone to have a discussion about their healthReview available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care)Conduct comprehensive member assessment that includes bio - psychosocial, functional, and behavioral health needsUtilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessmentIdentify when supplemental assessments are needed and conduct supplemental assessmentsIdentify member service needs related to health concernsIdentify urgent member situations and escalate to next level when necessaryEngage member to participate in the assessment process and collaboratively develop plan of care based on their individual needs, preferences, and objectivesWork with members to develop healthcare goals and identify potential barriers to achieving healthcare goalsIdentify member support systems available and incorporate into plan of careReview plan benefits and identify appropriate programs and services based on heath needs and benefitsIntegrate health care and service needs into a plan or recommendation for member care and serviceCollaborate with member to create solutions to overcome barriers to achieving healthcare goalsIdentify relevant community resources available based on member needsRefer members to appropriate programs and servicesFacilitate member choice of preferred providerEnroll members into appropriate programs and servicesUtilize motivational interviewing techniques to help member identify and understand their intrinsic goals and motivate members to engage in positive behavior changePresent complex case information to interdisciplinary care team and obtain input into member plans as necessaryCoordinate member access to health-related programs, services, and / or providersCoordinate with providers to facilitate member care and / or servicesFollow up with members to monitor and document completion of plan activities following standard protocolsProvide guidance or additional assistance to facilitate execution of plans or recommendations to improve member healthMonitor progress toward plan goals through evaluation of the effectiveness of programs and/or services providedMake changes to plans or recommendations based on evaluation outcomesResearch member-related health information (e.g., medications, clinical records, policies, benefit information) using internal and external systemsUse desk top computer applications (e.g., Excel, Word, Outlook, Office Communicator) to summarize information (e.g., reports) or communicate member information to others.Document information (e.g., assessment information, member interactions, referrals, follow up plans) in relevant computer systems.Navigate multiple applications at once to obtain and / or document member informationLearn updates and changes to computer systems / applications and apply to navigate applications effectivelyExecute and meet performance goals within a virtual environmentNavigate Virtual Call Center (VCC) system to receive inbound calls, make outbound calls, and document call time and activity appropriately
Required Qualifications:High School Diploma / GED.Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area2+ years of experience working within the community health setting in a Healthcare role.2+ years of experience working with community resources and support.Must reside in Louisville, KY for at least 1+ years.Must be able to create, edit, save and send documents utilizing Microsoft Word and Excel.Must be able to navigate a PC to open applications, send emails and conduct data entry.Must have the flexibility to travel to the office when required Preferred Qualifications:Knowledge of Medicare Regulations.Experience in Managed Care. Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SMDiversity 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.
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 t...hey 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.