RN Case Manager

In need of an RN with case management experience.

Primary Responsibilities:

• Selects, manages, develops, mentors and supports staff in designated department or region
• Develops clear goals and objectives for performance management and effectively communicates expectations, and holds the team accountable for results
• In order to meet the unique needs of our members, have an intimate understanding of the contractual requirements
• Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
• Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
• Participates in training and coaching of direct reports as needed
• Conducts bi-annual field visits with direct reports to observe, provide areas of teaching, address issues and concerns and foster a good working relationship
• Collaborates across Optum and UHG and interacted with Medical Directors, Site Directors, Senior Leaders, Network, Marketing, Account Management, Quality, Product, and other stakeholders

Required Qualifications:
• Resident of Indiana
• BSN or BSW with equivalent experience
• Registered Nurse with an unrestricted License in Indiana
• Experience working within the community health setting in a health care role
• Experience or knowledge of Indiana Medicaid, Medicare, Long term care
• Experience coaching or mentoring staff
• Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment

Preferred Qualifications:
• 3+ year of case management leadership experience within a healthcare industry
• Background in managed care
• Case Management experience
• Certified Case Manager (CCM)
• Experience / exposure with members receiving long term social supports
• Experience in utilization review, concurrent review and/or risk management