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Registered Nurse Case Manager CHF, Reliant Medical Group

Company: UnitedHealth Group
Location: North Grafton
Posted on: November 25, 2022

Job Description:

Opportunities with -Reliant Medical Group. -When you join Reliant, you'll be part of a community-based, multi-specialty, physician-led medical group. Everyone works collaboratively on a common purpose: improving the quality, cost and experience of health care. With the resources of a global health organization - Optum - behind us, we're at the forefront of value-based care. Supported by a patient-centric business model - integrated care teams focus on the best patient care, rather than volume. Here, you'll contribute to an exceptional patient experience. Discover a place where you can help shape the future of health care and do -your life's best work.(sm)
Reliant Medical Group is seeking a compassion, enthusiastic and professional Registered Nurse Case Manager to join their Care Management team in Worcester, MA. This is a full-time, Monday - Friday position
The Nurse Case Manager -(NCM) is responsible for patient case management for longitudinal engagement, coordination for discharge planning, transition of care needs and outpatient patient management through the care continuum. Nurse Case Manager will identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a patients' action plan and/or discharge plan. The Case Manager may perform telephonic and/or face-to-face assessments. They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers, educators, health care coordinators/managers. The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence. The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions. The Nurse Case Manager will act as an advocate for patients and their families guide them through the health care system for transition planning and longitudinal care. The Nurse Case Manager will work in partnership with the care team and will coordinate, or provide appropriate levels of care under the direct supervision of an RN Manager or MD. -
Primary Responsibilities:


  • Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care
  • Independently serves as the clinical liaison with hospital, clinical and administrative staff within our documentation system for discharge planning and/or next site of care needs.
  • In partnership with care team, make referrals to community sources and programs identified for patients
  • Assess and identify the healthcare, educational, and psychosocial needs of the patient and their family at the initial referral to care management
  • Provide member education to assist with self-management goals, disease management or acute condition and provide indicated action plan
  • In consultation with the manager of Care Management, conducts initial assessments within designated time frames for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environmental, and financial)
  • Collaborates effectively with Interdisciplinary Care Team (IDCT) to establish an individualized transition plan and/or action plan for patients
  • Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding high risk cases and participates in departmental huddles
  • Assists with data collection and closing of care gaps and quality metrics as assigned, and assists the healthcare team in meeting all of the quality metrics

    You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
    Required Qualifications:

    • Current, unrestricted RN license required specific to the state of employment
    • Current Massachusetts drivers license
    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodatio

      Preferred Qualifications:

      • Bachelor's Degree in Nursing
      • Certification in Case Management (CCM)
      • Experience with Complex Case Management and DSNP NCQA requirements
      • Managed care and/or case management experience
      • Experience working with geriatric patient populations

        -
        TTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
        Opportunities with Reliant Medical Group. -When you join Reliant, you'll be part of a community-based, multi-specialty, physician-led medical group. Everyone works collaboratively on a common purpose: improving the quality, cost and experience of health care. With the resources of a global health organization - Optum - behind us, we're at the forefront of value-based care. Supported by a patient-centric business model - integrated care teams focus on the best patient care, rather than volume. Here, you'll contribute to an exceptional patient experience. Discover a place where you can help shape the future of health care and 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.

Keywords: UnitedHealth Group, Worcester , Registered Nurse Case Manager CHF, Reliant Medical Group, Executive , North Grafton, Massachusetts

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