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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 health
Review 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 needs
Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessment
Identify when supplemental assessments are needed and conduct supplemental assessments
Identify member service needs related to health concerns
Identify urgent member situations and escalate to next level when necessary
Engage member to participate in the assessment process and collaboratively develop plan of care based on their individual needs, preferences, and objectives
Work with members to develop healthcare goals and identify potential barriers to achieving healthcare goals
Identify member support systems available and incorporate into plan of care
Review plan benefits and identify appropriate programs and services based on heath needs and benefits
Integrate health care and service needs into a plan or recommendation for member care and service
Collaborate with member to create solutions to overcome barriers to achieving healthcare goals
Identify relevant community resources available based on member needs
Refer members to appropriate programs and services
Facilitate member choice of preferred provider
Enroll members into appropriate programs and services
Utilize motivational interviewing techniques to help member identify and understand their intrinsic goals and motivate members to engage in positive behavior change
Present complex case information to interdisciplinary care team and obtain input into member plans as necessary
Coordinate member access to health-related programs, services, and / or providers
Coordinate with providers to facilitate member care and / or services
Follow up with members to monitor and document completion of plan activities following standard protocols
Provide guidance or additional assistance to facilitate execution of plans or recommendations to improve member health
Monitor progress toward plan goals through evaluation of the effectiveness of programs and/or services provided
Make changes to plans or recommendations based on evaluation outcomes
Research member-related health information (e.g., medications, clinical records, policies, benefit information) using internal and external systems
Use 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 information
Learn updates and changes to computer systems / applications and apply to navigate applications effectively
Execute and meet performance goals within a virtual environment
Navigate Virtual Call Center (VCC) system to receive inbound calls, make outbound calls, and document call time and activity appropriately
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.