TRICARE RN Maternal Case Manager - Colorado Springs, CO at Colorado Springs

Job Description

Talk about meaningful work. Talk about an important role. Lets talk about your next career move. Our UnitedHealthcare Military & Veterans organization has been selected to provide quality health care services for those who serve our nation. This is an opportunity to share in something special; an opportunity for all of us to serve those families who have made our nation stronger. Its an inspiring role and it can inspire your career. Find out more about these opportunities to do your lifes best work.(SM) UnitedHealthcare Military and Veterans have an excellent opportunity available to join our company as aCase Manager for the Healthy High Risk Pregnancy. Positions in this function include RN (with current licensure) roles that identify, coordinate, or provide appropriate levels of care under the direct supervision of an RN or MD.This position would beresponsible for clinical operations and medical management activities across and continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management coordination of care, and medical management consulting.This positionis responsible for providing health education, coaching and treatment decision support for beneficiaries. TRICARE RN Maternal Case Manager Healthy High Risk Pregnancy**This is a office position located at 9945 Federal Drive, Colorado Springs, Colorado***Responsibilities: Document all clinical information in accordance with UnitedHealthcare Military & Veterans policies and proceduresAssess and interprets beneficiary needs, gaps, and requirementsLeads efforts to provide specialized case management services to beneficiaries identified with very complex conditions or diseases requiring intensive and extensive coordination of resources including accessing Centers of Excellence with specialty hospitals, multiple specialists and sub-specialists, DME, home care and therapy providers.Solves moderately complex problems and/ or conducts moderately complex analysesDevelops plan of care in collaboration with beneficiary/caregiver/providerWorks with minimal guidance, seeks guidance on only the most complex tasksTranslates concepts into practiceProvides explanations and information to others on difficult issuesCollaborates with specialists, physicians, and medical directors to provide the necessary care and cost efficient care for the beneficiaryAssesses the effectiveness and quality of services provided related to clinical, functional, and financial impact and outcomesCoordinating services as neededMaximizes use of community services, support programs, and resources available to beneficiaryEducating beneficiary on disease processesAssist with projects and/or assignments designated by the Team Lead, Supervisor or ManagerAdhere to the timeframes surrounding contractual terms as related to obtaining clinical information, communication with providers and internal disciplinesRefer all cases that fall outside of standard criteria to the medical Director for review, per UnitedHealthcare Military & Veterans policy and procedureAdheres to ethical, legal/regulatory and accreditation standards

Job Requirements

2-5 years of experience in a clinical setting in maternal child nursingUnrestricted, RN license in the state of residenceExperience working with the military is desiredCase management experience desiredUnited States Citizenship requiredAbility to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86Bachelors degree preferred-Undergraduate degree or equivalent experience, including specialty experience where requiredClinical competence in understanding hopital care and care coordinationBusiness background and/or experience preferredAbility to develop and sustain trusting and respectful relationships with beneficiaries, families, advocates, medical partners and othersDetail oriented and organizedFlexible schedule Approved Case Management certification is preferred, or obtainment of certification within 18 months of hire on assuming the positionFamiliar with Microsoft Word & Excel and has computer/technical aptitudeAs a requirement of UnitedHealth Groups contract with the Department of Defense, this position requires U.S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 www.opm.gov/forms/pdf_fill/sf86.pdf, (the National Agency Check or NAC). Successful completion of the NAC process is a requirement for continued employment in this role. NAC processing will be initiated by our TRICARE Security Officer post-offer, and can take 3-6 months for a final decision communication from the Department of Defense. Candidates will be allowed to begin employment with UnitedHealth Group in this role based on an interim clearance, and final results will be communicated as they are received. Failure to obtain final NAC approval will result in termination from this role.Careers at UnitedHealthcare Military & Veterans. When it comes to their health care, the men and women who help keep the peace deserve the greatest peace of mind. Thats why UnitedHealthcare is the organization thats called on to serve them and their loved ones. Were all about finding better ways to help improve their lives no matter where life may take them. So our career opportunities take challenge to a higher level. If you have a commitment to quality that mirrors our commitment to the men and women of the armed forces, take time to learn more about the career paths available here. Its a genuine opportunity to do your lifes best work. Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VAll qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.Key Words: CM, Case Management, Nurse, RN, Healthy High Risk Pregnancy, OBGYN, Colorado Springs, CO, military, TRICARE,Maternal, Colorado
Country: USA, State: Colorado, City: Colorado Springs, Company: UnitedHealth Group.