RN Case Manger - Manitowoc and Sheboygan, WI

UnitedHealth Group - Sheboygan, WI

Full-time - Entry Level

Sheboygan, WI

Insurance Carriers and Related Activities

About the position

The RN Case Manager at UnitedHealth Group plays a crucial role in providing care coordination for patients in long-term care settings, such as nursing homes and assisted living facilities. This position involves collaborating with interdisciplinary teams to ensure that patients receive comprehensive care that addresses their physical, mental, and social needs. The RN will work under the direction of the Advanced Practice Clinician and the Clinical Services Manager, focusing on improving patient outcomes and facilitating seamless health journeys.

Responsibilities

• Assist the provider/team with various care coordination activities in the nursing home.
• Assist the provider/team with benefit determination associated with Medicare part A, part B, and part D benefits.
• Collaborate with the primary Advanced Practice Clinician (APC) and nursing facility to identify and respond to patient Change in Condition.
• Complete Decision Support Tool (DST), re-assess the patient, and other activities as delegated by the provider or the Clinical Services Manager (CSM).
• Assist the provider/team with therapy coordination for members including possible assessments or follow-up on requests and communicate and collaborate with APC.
• Perform interval check-ins on patient progress with the therapy department.
• Participate in facility-based therapy discussion meetings.
• Schedule and participate in family conferences, team meetings, and team case presentations.
• Assist in the coordination of training, tracking, and compliance with quality measures.
• Participate in the onboarding of new clinical staff under the direction of the CSM Manager.
• Participate in facility partnership or Customer Relationship Management (CRM) meetings under the direction of the APC/CSM.
• Assist in coordinating CRM meetings and may participate in and contribute to the meetings.
• Assist the team in tracking LearnSource completion for the team members and CSM.
• Create and conduct in-services for selected audiences.
• Document information and activities in the EMR.
• Assist Providers in assuring complete and accurate documentation and coding, medication reconciliation, nursing rounds, assessment, and patient documentation.
• Assist the team/providers in prioritizing advance Care Planning and initiating discussions.
• Collaborate with all key stakeholders, providers, nursing homes, PCPs, families, interdisciplinary care teams, and any other identified stakeholders.
• Review the chart and enter HEDIS/Quality information into the Electronic Medical Record (EMR), communicate gaps to the Provider.
• Write verbal orders from Provider in the chart in compliance with the state RN practice laws and in compliance with individual nursing facility practices.
• Conduct goals of care conversations.

Requirements

• Associate degree or higher in Nursing (RN).
• Current unrestricted Registered Nurse license in the state.
• Certified in Basic Life Support.
• Valid Driver's License with access to reliable transportation that will enable you to travel up to 100% to visit clients and/or patient sites within a designated area.

Nice-to-haves

• Bachelor's degree.
• 1+ years of experience in post-acute care, such as long-term care.
• 1+ years of experience working with the geriatric population.
• 1+ years of experience with using Electronic Medical Records.
• Experience conducting in-services.
• Familiarity with Medicare part A, part B, and part D benefits.
• Familiarity with the long-term care business environment.
• Basic Microsoft Office skills with the ability to navigate in a Windows environment.
• Proven ability to work with diverse care teams in a variety of settings.

Benefits

• 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.).