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. This is a field-based position with a home-based office for consideration you must reside within a commutable distance of the Northern VA Markets. The Field Care Coordinator is responsible for facilitating, promoting, and advocating for the enrollees' ongoing self-sufficiency and independence. This position is responsible for assessment and planning for an identified group of patients. Additionally, the care coordinator is responsible for assessing the availability of natural supports such as the enrollee's representative or family members to ensure the ongoing mental and physical health of those natural supports. The Field Care Coordinator collaborates with the Interdisciplinary Team to coordinate the delivery of comprehensive, efficient, cost-effective patient care. The Field Care Coordinator will be traveling into enrollees' homes, nursing facilities, Adult Day Health, and Adult Living Facilities (ALF) to conduct in-depth assessments and develop the plan of care. The Field Care Coordinator actively assists enrollees with care transitions in collaboration with the Interdisciplinary Team and the acute or skilled facility staff, and the enrollees and / or the enrollees' representatives. Field Care Coordinators act as liaison between the Health Plan, the Commonwealth, enrollees, and their families. Field Care Coordinators follow established professional standards of care, Commonwealth guidelines and policy and procedures. If you reside within a commutable distance of Northern VA, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team 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 and unrestricted Licensed Practical Nurse in the state of Virginia OR Social Work or Human Services (or related field) with a 4-year degree 3+ years of care coordination or behavioral health experience and/or work in a healthcare environment 1+ years of experience with MS Office, including Word, Excel, and Outlook Experience working with members who have medical needs, the elderly, individuals with physical disabilities and / or those who may have communication barriers Driver's license and reliable transportation and the ability to travel within assigned territory to meet with members and providers Preferred Qualifications CCM certification Experience working with Medicaid / Medicare population Experience working in team-based care Long term care / geriatric experience Background in Managed Care All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This role will require the ability to work a on Saturday either in a traditional 5 day work week schedule or working 4-10 hour shifts Primary Responsibilities Conducts reviews of member and provider appeals Analyzes claim adjustment and claim history Reviews history of previous reviews Reviews denied services in conjunction with policies and procedures, benefit plans, federal and state regulations, and clinical criteria to and renders approval when appropriate Extrapolates and summarizes medical information for review by Medical Director, as needed Balances the need to produce high quality work with meeting timeframes and production goals 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 license in state of residence 5+ years of clinical experience as an RN including in an acute, inpatient hospital setting Experience applying benefits and criteria to clinical review Utilization Management, pre-authorization, concurrent review or appeals experience Solid computer skills including proficiency in Microsoft Office Word, Outlook, and Internet applications Ability to access multiple computer platforms Access to install secure high-speed internet (minimum speed 5 download mps & 1 upload mps) via cable/DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement) Designated quiet workspace in your home (separated from non-workspace areas) and able to be secured to maintain Protected Health Information (PHI) and/or Protected Information (PI) Ability to work a on Saturday either in a traditional 5 day work week schedule or working 4-10 hour shifts Preferred Qualifications Bachelor of Science in Nursing Medical Coding experience/knowledge Experience using Interqual Experience with the following systems: UNET, iCUE/HSR, ATS, ETS or Cirrus Experience analyzing medical records, benefit plans, medical policies and other various criteria Demonstrated ability to work independently with solid self-discipline and time management skills Demonstrated excellent communication, interpersonal, problem-solving, and analytical skills All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together The Clinical Quality LPN engages in a collaborative process with members of a multidisciplinary team which may include a Physician, Nurse Practitioner, RN Care Manager, Social Worker, Pharmacist, Clinical Quality Coordinator, and Medical Assistant, to improve HEDIS and STARs scores. The Clinical Quality LPN performs a wide variety of duties and is responsible for driving clinical relationships and engagement with providers, patients, and pharmacies with a goal of improving health, well-being, and quality performance. This position is accountable for the full range of clinical practice performance which may include but is not limited to improvement on HEDIS and STARs gap closures. This role develops a comprehensive, provider-specific plan to increase their physician practice performance and improve their outcomes. If you are located in New Orleans, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities Run/pull/prioritize/distribute Quality and Med Adherence reports for all Quality Contract Payors Analyzes data collected and makes recommendations for process improvements Assist in the development and implementation of new policies and procedures designed to enhance quality care Perform Chart reviews to identify open gap measures Communicate with Clinical Team on open gaps Available resource for Clinical questions from Clinical Quality Administrative Coordinator Perform Med Adherence Calls Maintain Quality reports for each provider Perform initial and follow-up calls to patients for open gap measures Review/interpret internal medical records/data to determine whether there is documentation that medical services were rendered to close Quality Gaps Manipulate and leverage multiple databases/Electronic Medical Records applications to sort, search, and enter information Identify incomplete/inconsistent information in medical records and label missing measures/metrics/concerns 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 and unrestricted Louisiana LPN License 2+ years of HEDIS and STARs measures experience 2+ years of health care industry experience Proven solid computer skills required including knowledge of Microsoft Word, Excel, and EPIC Physical Demands/Working Conditions Must be able to lift 10-15 pounds and operate standard office equipment, computer, printer, fax and copier Must have dependable transportation and be able to travel periodically to all clinic locations Core Competencies Sets priorities for work assignments and uses initiative in completion of tasks Professionalism Flexible Goal oriented Independent Team Player Excellent with follow-through and completion Enjoys working with detail and organization Produces highly accurate work Able to meet deadlines Solid verbal and written communication skills Ability to interface with multiple levels of the medical profession Understanding of the healthcare industry All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
$5,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS 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. The RN Field Clinical Care Coordinator, you will be an essential element of an Integrated Care Model by relaying the pertinent information about the members' needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. If you reside within a commutable distance to the Mystic Valley, MA and surrounding areas (Malden, Lynn, Cambridge, Somerville, Medford, Everett, Saugus, Reading, Peabody), you will have the flexibility to work telecommute* as you take on some tough challenges. This is a Field-based role. Expect to spend about 50% of your time in the field visiting our members in their homes or in long-term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Assess, plan and implement care strategies that are individualized by patients and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members What Are The Reasons To Consider Working For UnitedHealth Group? Put It All Together - Competitive Base Pay, a Full And Comprehensive Benefit Program, Performance Rewards, And a Management Team Who Demonstrates Their Commitment To Your Success. Some Of Our Offerings Include Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement Employee Discounts Employee Assistance Program Employee Referral Bonus Program Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) More information can be downloaded at: http://uhg.hr/uhgbenefits 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 and unrestricted independent licensure as a Registered Nurse in the state of MA 2+ years of clinical experience Intermediate level of proficiency with MS Office, including Word, Excel and Outlook Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Ability to travel in assigned regions to visit members in their homes and/or other settings, including community centers, hospitals or providers' offices Access to reliable transportation & valid US driver's license Preferred Qualifications Bachelor's or master's degree in nursing Certified Care Manager (CCM) 1+ years of community case management experience coordinating care for individuals with complex needs Experience working in team-based care Background in Managed Care Ability to utilize an Electronic Medical Record or other electronic platforms Bilingual Physical Requirements Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations is needed for visits (ex. laptop, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED
$5,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS 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. The RN Field Clinical Care Coordinator, you will be an essential element of an Integrated Care Model by relaying the pertinent information about the members' needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. If you reside within the Bridgewater, MA and surrounding areas market, you will have the flexibility to work telecommute* as you take on some tough challenges. This is a Field-based role. Expect to spend at least 50% of your time in the field visiting our members in their homes or in long-term care facilities. You'll need to be flexible, adaptable and, above all, patient in all types of situations. Primary Responsibilities Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Assess, plan and implement care strategies that are individualized by patients and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members What Are The Reasons To Consider Working For UnitedHealth Group? Put It All Together - Competitive Base Pay, a Full And Comprehensive Benefit Program, Performance Rewards, And a Management Team Who Demonstrates Their Commitment To Your Success. Some Of Our Offerings Include Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays Medical Plan options along with participation in a Health Spending Account or a Health Saving account Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage 401(k) Savings Plan, Employee Stock Purchase Plan Education Reimbursement Employee Discounts Employee Assistance Program Employee Referral Bonus Program Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) More information can be downloaded at: http://uhg.hr/uhgbenefits You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 and unrestricted independent licensure as a Registered Nurse for MA 2+ years of clinical experience Intermediate level of proficiency with MS Office, including Word, Excel, and Outlook Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service Ability to travel in assigned regions to visit members in their homes and/or other settings, including community centers, hospitals or providers' offices Access to reliable transportation & valid US driver's license Preferred Qualifications Bachelor's or Master's Degree in Nursing Certified Care Manager (CCM) 1+ years of community case management experience coordinating care for individuals with complex needs Experience working in team-based care Background in Managed Care Ability to utilize an Electronic Medical Record or other electronic platforms Bilingual-Spanish, Khmer Physical Requirements Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members and/or providers Ability to transport equipment to and from field locations is needed for visits (ex. laptop, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. PLEASE NOTE** The sign-on bonus is only available to external candidates. Candidates who are currently working for UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED
