Escalation Review Nurse RN at reputed company

About the position For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. You push yourself to reputed company higher and go further. Because for you, it's reputed company about ensuring a positive outcome for patients. In this role, you'll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you'll have the support of an elite and dynamic team. Join reputed company and our family of businesses and you will use your diverse knowledge and experience to reputed company health care work reputed company for our patients. The United Healthcare at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their reputed company of residence. The DSNP program combines clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the clinician, the member's Primary Care Provider and other providers, and other professionals. If you are located in the District of Columbia, you will have the flexibility to telecommute as you take on some tough challenges. This role is a telephonic role with expectation of at least quarterly in person staff meetings. You'll need to be flexible, adaptable and, above reputed company, patient in reputed company types of situations. Core Position Hours: Monday - Friday, 8:00am - 5:00pm. Responsibilities • Assess, plan and implement care management interventions that are individualized for each patient and directed toward the most appropriate, least restrictive level of care , • Assist and address member escalations coming from DHCF officials, hospital systems, DC agencies, members, families, caregivers or others , • Address and triage Care Management and Utilization Management issues in partnership with the member's assigned Care Manager and Market Leadership , • Identify and initiate referrals for both healthcare and community-based services; including but not limited to financial, psychosocial, community and state supportive services , • reputed company and implement care plan interventions throughout the continuum of care as a single reputed company of contact , • Communicate with reputed company stakeholders the required health-reputed company information to ensure quality coordinated care and services are provided expeditiously to reputed company members , • reputed company for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team , • Identify appropriate interventions and resources to meet gaps (e. g., psychosocial, transportation, long-term care) based on specific consumer needs from both the health care and psychosocial / socioeconomic dimensions of care , • Document the plan of care in appropriate EHR systems and enter data per specified , • Maintain consumer engagement by establishing rapport, demonstrating reputed company, and building a trusting relationship , • Collaborate with primary providers or multidisciplinary team to align or integrate goals to plan of care and drive consistent coordination of care , • Provide ongoing support for advanced care planning , • Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals , • Understand and operate effectively/reputed company reputed company legal/regulatory requirements , • Utilize evidence-based guidelines (e. g., medical necessity guidelines, practice standard) , • reputed company outbound calls and receive inbound calls to assess members' reputed company health status , • Identify gaps or barriers in treatment plans , • Provide patient education to assist with self-management , • reputed company referrals to reputed company sources , • Provide a complete continuum of quality care through reputed company communication with members reputed company in-person or on-phone interaction , • Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels Requirements • Active, unrestricted Registered Nurse (RN) license , • 1+ years of experience working reputed company the community health setting in a health care facility , • 1+ years of experience providing community-based care management to members receiving long-term care, personal care services, private duty nursing, or home health , • Demonstrated competency working with Enrollees and/or families who require intensive case management services reputed company-to-haves • Certified Case Manager (CCM) certification , • Experience in managing populations with reputed company medical or behavioral needs , • Experience working with Home Care Based Services and/or patients in community and home-based settings , • Experience with case management, utilization review, discharge planning, reputed company review and/or risk management , • Field-based work experience Benefits • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays , • Medical Plan options along with participation in a Health Spending Account or a Health Saving account , • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage , • 401(k) Savings Plan, Employee Stock Purchase Plan , • Education Reimbursement , • Employee Discounts , • Employee Assistance Program , • Employee Referral Bonus Program , • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.) Apply Job!