RN Field Case Manager - Maternal Health - Remote in Lexington, KY

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

As a Maternal Health RN, you will act in a clinical liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The RN works in a team-based structure and spends 25% of their time in the community engaging directly with members. You will work with medically complex patients who may be experiencing significant addiction and/or behavioral health conditions is important for this role.

This is high volume, customer centric environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone and in person. Solid computer and software navigation skills are critical. 

If you are located in or within commutable driving distance to Lexington, Paris, Nicholasville, and/ or Carlisle, KY, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Making outbound calls to assess members' current health status
• Manage highly complex members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), OB providers, behavioral health providers, etc.
• Consult with care team to address specialty care services, community-based resources, and other member complex care needs
• Assist in identification of pregnant women and children including those with special health care needs and access/linkages to appropriate care
• Working with the complex maternity care needs
• Identifying gaps or barriers in treatment plans
• Providing patient education to assist with self-management
• Interacting with Medical Directors, providers, internal and external partners on challenging cases
• Coordinating care for high risk maternity members
• Making referrals and connecting members to community resources
• Coordinating services as needed (home health, DME, etc.)
• Educating members on disease processes
• Educating members on (e.g. inter-conception care, chronic condition management, smoking cessation, safe sleep for infants, breast feeding advantages, substance use avoidance, etc.)
• Encouraging members to make healthy lifestyle changes
• Documenting and tracking findings

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 in the State of Kentucky
• 3 years of experience in a hospital setting, acute care, direct care experience as an RN and / or experience as a telephonic Case Manager for an insurance company
• 2 years of High-Risk OB clinical nursing experience plus current / prior position as a Case Manager OR 3 years of High-Risk OB clinical nursing experience 
• Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, Internet research, use of online calendars and other software applications
• Proficiency with Microsoft Office Suite, with the ability to navigate a Windows environment
• Live in or within commutable driving distance to Lexington, Paris, Nicholasville, and/ or Carlisle, KY

• Access to reliable transportation and the ability to travel up to 25% within assigned region to visit Medicaid members in their homes and / or other settings, including community centers, hospitals or providers' offices

• Must be able to attend one week of onsite training in Louisville, KY office (travel accommodations provided)

Preferred Qualifications:

• Certified Case Manager (CCM)
• Background in managed care
• Experience in pediatrics or NICU
• Medicaid experience
• Case Management experience
• Experience working with chronic illness and complex care needs population 
• Experience in utilization review, concurrent review and / or risk management 
• Experience with HIV population
• Psychiatric or Behavioral Health experience
• Proven bilingual Spanish speaking
• Proven excellent Communication and Writing skills
• Proven problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Proven 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

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 

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.