The Sr. Field RN Case Manager for the TX STAR Kids Program will manage the care of members in their homes or other community settings by completing in-person health assessments and coordinating patient care, focusing on disease management and keeping members healthy and independent.
Travel 75% of the time.
* Engaging members / families in their homes or in a facility to coordinate services, community resources and treatment needs * Travel in assigned territory as needed to complete member assessments; the rest of the time will be spent working in a home-based office * Delivering a holistic approach to coordinated care based on the member's needs using a person centered approach * Ensure LTSS and clinical programs are in place according to members wants and needs to include functional, medical, behavioral and social needs * Support members desires to live in the least restrictive setting as possible * Assist members with the transition from a care facility back to their home * Identifying early risk factors and conducting ongoing assessments and documenting in an electronic file * Completes all initial and annual service planning activities, and verifies, authorizes, coordinates and monitors services * Creating, reviewing and revising care plans and focusing on a holistic approach * Functioning as an advocate for member * Collaborating with the member's PCP to deliver and coordinate necessary services * Building relationships with members and their families; assisting them with coordination of health choices * Ensuring cases are documented in a timely manner * Coordination with other state agencies, community resources and providers
* RN License, must be current and unrestricted in state of Texas * RUG certification or the ability to obtain within 30 days of employment * 3 years of recent experience as a RN in pediatrics including developmental challenges of the pediatric population * High Speed Internet access in home * Strong computer proficiency to include the ability to use Microsoft Word, Outlook and Internet on a daily basis * Access to reliable transportation and willingness to travel throughout surrounding area on regular basis
* Bachelor's Degree or Higher
* Experience with Medicare and / or Medicaid * MDCP (Medically Dependent Children's Program) experience * Case Management experience * Managed care experience * Bilingual (Spanish) * CCM certification * Experience with complex populations
Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)
Diversity 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.
Job Keywords: TXSTARKIDS, RN, nurse, case manager, case management, CCM, Medicaid Waver, Medicaid, MDCP, pediatrics, field based, home care, home health, complex case management, managed care, bilingual, Brazoria, Texas, TX