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Complex RN Case Manager - Telecommute near Wausau, WI

UnitedHealth Group

Wausau, WI
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Job Details

755409 Complex RN Case Manager Telecommute near Wausau WI

Complex RN Case Manager - Telecommute near Wausau, WI (755409)

Position Description

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. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)


The Telephonic Complex Nurse Case Manager RN performs general and high risk, complex Case Management activities across the continuum of care to drive and support proactive quality, cost efficient outcomes and minimize fragmentation of health care delivery. The Complex Case Manager works with consumers, caregivers, and providers focusing on preventing avoidable admission/readmission to hospitals, emergency departments, other facilities and high cost services. The Complex Case Manager leads a collaborative process of assessment, planning, facilitation, and advocacy to meet individual and population health needs.    
The Complex Case Manager functions across the continuum of telephonic Case Management, with the overall goal of activating the consumer to enhance quality of care, to facilitate change in consumer behavior and to promote optimal outcomes for all parties involved.    
If you are located live within 35 miles of the Wausau, WI office, you will have the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:    
  • Responsible for developing case management workflows, meeting with clients and managing  members that are local to the area linking them with  providers and community support.
  • Meet the customer(s) at their office near Wausau approximately 2-4 times per month.

  • Conduct initial and follow-up assessments within designated timeframes on patients identified as having highest risk complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial)
  • Utilize holistic approaches to patient care and integrates patient's life and motivational goals into the treatment plan
  • Prioritize care needs, set goals and develop a treatment plan (or plan of care) that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation
  • Track the patient's health status and progress in achieving clinical and personal goals
  • Provide education, information, direction, and support related to care goals of patients
  • Communicate with patients, families, caregivers, physicians, and other service providers to coordinate the care needs for the patient
  • Work to facilitate patient compliance and to ensure continuity of care
  • Monitor and evaluate the patient's response to treatment(s)
  • Collaborates with internal Medical Directors to attain optimal outcomes and cost efficient services
  • Document assessments, interventions, and follow-up on Case Management activities
  • Regularly assess the effectiveness and quality of services provided to patients by analyzing outcomes (clinical, functional, and financial)
  • Maintain a focus on timely, quality customer service
  • Maintain a focus on the customer service through policy and program decisions and consider impact of these activities on the members
  • Facilitate problem resolution with members, providers, and other agencies or entities as needed
  • Promotes cost efficient health care consistent with adding value for consumers, customers and business
  • Serves as consumer advocate and maintains consumer's privacy, confidentiality and safety
  •  Adheres to ethical, legal/regulatory and accreditation standards
  • Participates in special projects, initiatives, and other job duties as assigned
This position will require active and unrestricted Nursing licensure in multiple US States.  Selected candidate must be willing and able to obtain and maintain multiple state licensure. (Application fees and filing costs paid for by UHG)   
Required Qualifications:      
  • Registered Nurse (RN) with current active and unrestricted license in the State of residence
  • Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses required
  • 3+ years of hands-on clinical RN experience in a hospital, acute care, inpatient, home health/hospice or direct care environment
  • Willingness to obtain NCQA approved Case Management Certification (CCM) within 30 months of assuming the position for those who are not currently CCM certified
  • Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
Preferred Qualifications:      
  • Experience in Managed Care
  • Bachelor’s Degree or higher
  • Case Management experience
  • Certification in Case Management (CCM)
  • Home Health or Hospice experience
  • Utilization Management experience
  • Medical Surgical experience
  • Oncology experience
  • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
  • Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others   
  • Reside within 35 miles of Wausau, WI

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


 *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.


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: RN, registered nurse, CCM, case management, Medical Surgical, Med Surg, Oncology, Wausau, WI, Wisconsin, Complex Care, Acute Care, utilization management, telecommute

Job Details

  • Contest Number755409
  • Job TitleComplex RN Case Manager - Telecommute near Wausau, WI
  • Job FamilyNursing
  • Business SegmentOptum Operations

Job Location Information

  • Wausau, WI
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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