The Sr RN Case Manager for the 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. Will be covering the following: Jackson, TX / Brazos, TX / Washington, TX / Dewitt, TX / Colorado, TX. Primary Responsibilities: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
Required Qualifications:Current and unrestricted RN License in the 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 basisPreferred Qualifications:Bachelor's Degree or Higher CCM certification Experience with Medicare and / or Medicaid MDCP (Medically Dependent Children's Program) experience Case Management experience Managed care experience Bilingual (Spanish) Experience with complex populationsCareers 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, Jackson, Brazos, Washington, Dewitt, Colorado, TX, Texas
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.