OB RN Field Case Manager role in Mississippi with Americhoice. T - (US-MS-Jackson - 39298)

Minimum Education: None
Jobcode: 60144340
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UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.

AmeriChoice is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
 
If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at AmeriChoice.
 
We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.
 
This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.
 
As a Case Manager, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating.  This may include case management, disease management, coordination of care and medical management consulting.  You will also be responsible for providing health education, coaching and treatment decision support for members. Case Managers work in a variety of settings: in the community providing proactive care coordination to individuals and support to their families or in telephonic care management position.
 
Position functions include:
         Perform telephonic case management for all high risk member's
         Apply appropriate standard criteria Milliman/Interqual (PA only) to all clinical review received.
         Refers all cases that fall outside of standard criteria to the Medical Director for review, per HFS policy and procedure
         Document all clinical information in accordance with HFS policies and procedures in the member's electronic medical record.
         Adhere to the timeframes surrounding contractual terms as related to obtaining clinical information, communication with providers and internal disciplines
         Participate in scheduled rounds with interdisciplinary team
         Maintain open communication with interdisciplinary team
         Manage time efficiently while consistently meeting established productivity and quality standards
         Assist with projects and/or assignments designated by the Team Leader, Supervisor or Manager
         Must be flexible and team oriented.
         Other duties as Assigned


 
You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.



Experience: Qualifications for this role include:
 
         Clinical Registered Nurse with current licensure in the state of Mississippi required.
         Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements
         3+ years Obstetrical experience
         A minimum of 1 year case management experience required, CCM preferred

Ability to travel frequently within an assigned territory.  Must posses reliable transportation.