Introduction to UnitedHealth Group and Our Mission
At UnitedHealth Group, we are dedicated to helping people live healthier lives and making the health system work better for everyone. We are a team of passionate and committed individuals who strive to deliver high-quality, patient-centered care to those we serve. Our organization is built on a foundation of integrity, compassion, and innovation, and we are constantly seeking talented professionals to join our team and help us achieve our mission.
About the Position: Escalation Review Nurse RN
We are seeking an experienced and skilled Escalation Review Nurse RN to join our team in a remote capacity. As an Escalation Review Nurse RN, you will play a critical role in assessing, planning, and implementing care management interventions that are individualized for each patient and directed toward the most appropriate, least restrictive level of care. You will work closely with patients, families, caregivers, and healthcare providers to address member escalations, identify and initiate referrals for healthcare and community-based services, and develop and implement care plan interventions throughout the continuum of care.
Key Responsibilities:
- Assess, plan, and implement care management interventions that are individualized for each patient and directed toward the most appropriate, least restrictive level of care
- Assist and address member escalations coming from DHCF officials, hospital systems, DC agencies, members, families, caregivers, or others
- Address and triage Care Management and Utilization Management issues in partnership with the member's assigned Care Manager and Market Leadership
- Identify and initiate referrals for both healthcare and community-based services, including but not limited to financial, psychosocial, community, and state supportive services
- Develop and implement care plan interventions throughout the continuum of care as a single point of contact
- 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 healthcare team
- Identify appropriate interventions and resources to meet gaps (e.g., psychosocial, transportation, long-term care) based on specific consumer needs from both the healthcare and psychosocial/socioeconomic dimensions of care
- Document the plan of care in appropriate EHR systems and enter data per specified requirements
- Maintain consumer engagement by establishing rapport, demonstrating empathy, and building a trusting relationship
- Collaborate with primary providers or multidisciplinary team to align or integrate goals to plan of care and drive consistent coordination of care
- Provide ongoing support for advanced care planning
- Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals
- Understand and operate effectively/efficiently within legal/regulatory requirements
- Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standard)
- Make outbound calls and receive inbound calls to assess members' current health status
- Identify gaps or barriers in treatment plans
- Provide patient education to assist with self-management
- Make referrals to outside sources
- Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
- Support members with condition education, medication reviews, and connections to resources such as Home Health Aides or Meals on Wheels
Essential Qualifications:
To be successful in this role, you will need to possess the following essential qualifications:
- Active, unrestricted Registered Nurse (RN) license
- 1+ years of experience working within the community health setting in a healthcare facility
- 1+ years of experience providing community-based care management to members receiving long-term care, personal care services, private duty nursing, or home health
- Demonstrated competency working with Enrollees and/or families who require intensive case management services
Preferred Qualifications:
While not required, the following preferred qualifications will make you a more competitive candidate for this role:
- Certified Case Manager (CCM) certification
- Experience in managing populations with complex medical or behavioral needs
- Experience working with Home Care Based Services and/or patients in community and home-based settings
- Experience with case management, utilization review, discharge planning, concurrent review, and/or risk management
- Field-based work experience
Skills and Competencies:
To excel in this role, you will need to possess the following skills and competencies:
- Strong assessment, planning, and implementation skills
- Excellent communication and interpersonal skills
- Ability to work independently and as part of a team
- Strong problem-solving and critical thinking skills
- Ability to prioritize tasks and manage multiple responsibilities
- Strong attention to detail and organizational skills
- Ability to maintain confidentiality and handle sensitive information
- Strong knowledge of community resources and healthcare systems
- Ability to work in a fast-paced environment and adapt to changing priorities
Career Growth Opportunities and Learning Benefits:
At UnitedHealth Group, we are committed to helping our employees grow and develop in their careers. As an Escalation Review Nurse RN, you will have access to a wide range of training and development opportunities, including:
- Professional development programs
- Leadership development opportunities
- Mentorship programs
- Cross-functional training opportunities
- Education reimbursement programs
Work Environment and Company Culture:
Our company culture is built on a foundation of integrity, compassion, and innovation. We are a team of passionate and committed individuals who strive to deliver high-quality, patient-centered care to those we serve. As an Escalation Review Nurse RN, you will be working in a remote capacity, but you will still be an integral part of our team. You will have the opportunity to work with a diverse group of professionals who are dedicated to making a difference in the lives of our patients.
Compensation, Perks, and Benefits:
We offer a competitive salary and a comprehensive benefits package, including:
- 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.)
Conclusion:
If you are a motivated and compassionate individual who is passionate about delivering high-quality, patient-centered care, we encourage you to apply for this exciting opportunity. As an Escalation Review Nurse RN at UnitedHealth Group, you will have the opportunity to make a real difference in the lives of our patients and contribute to the success of our team. Don't miss out on this chance to join our team and start making a positive impact today!
Submit Your Application:
Seize this opportunity to make a significant impact. Apply now and take the first step towards a rewarding new role.
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