Telephonic Case Manager, RN Bilingual Spanish Required!

Want to learn more before applying for this role? Click here to view the Realistic Job Preview: Telephonic_Case_Manager_Optum.pdf 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. Primary responsibilities: Making outbound calls to assess members' current health status Identifying gaps or barriers in treatment plans Providing patient education to assist with self management Interacting with Medical Directors on challenging cases Coordinating care for members Making referrals to outside sources Coordinating services as needed (home health, DME, etc) Educating members on disease processes Encouraging members to make healthy lifestyle changes Documenting and tracking findings Utilizing Milliman criteria to determine if patients are in the correct hospital setting Making "welcome home" calls to ensure that discharged member receive the necessary services and resources Qualifications:Qualifications: Bilingual Spanish Current, unrestricted RN license in the State of IL or AZ (based on location) Requires minimum of 5 6 consumer hours per week (working after 5PM CST until 8PM CST) 3 years experience in a hospital setting, acute care, direct care experience OR experience as a telephonic Case Manager for another insurance company Computer proficiency including the ability to type and talk at the same time and to navigate a Windows environment Additional Assets Preferred: BSN A Background in managed care Certified Case Manager (CCM) Experience /exposure with discharge planning Experience in utilization review, concurrent review and/or risk management **Opportunity to work from home after 6 months with proven performance!** Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V UnitedHealth Group is a drug free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.CODE:RJC