UnitedHealth Group
Caring. Connecting. Growing Together.
The Private Duty Nurse Care Manager (RN) will be responsible for the overall management of a sub-population of DMAS-identified Mandatory High Priority members who must receive High Intensity care management and performing pre-service clinical reviews of Home & Community Based Services HCBS). If you reside within a commutable distance from the Central Virginia area, you will have the flexibility to work remotely* as you take on some tough challenges. *This is a field-based role that will require travel approximately 50% of the time in the field within an assigned coverage area. Candidates must be willing to travel throughout the state of Virginia; primarily in the Central Virginia area. Primary Responsibilities:
Meeting contractual requirements related to Initial HRA, MMHS Screening, ICPs, ICT, and minimum mandatory contacts Conducting face-to-face visits Oversight of PDN authorizations, including Utilization Management aspects of the authorization process Oversight of HCBS UM authorizations Participate in PDN Pod Rounds Provide primary case management across the continuum for these medically fragile and complex members to include following members through inpatient hospitalizations, assisting with transitions of care, and coordinating HCBS service needs (DME, EM/AT, PC/AC hours, and PDN hours) Serve as lead contributor to the oversight of and accountability for member-specific quality measures (HEDIS, NCQA) (will have support and assistance from Quality Department) Youll 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:
Bachelors degree in nursing Current, unrestricted RN license for the state of Virginia 1+ years of care coordination and/or work in a healthcare environment 1+ years of private duty nursing, trach, ventilator, ICU/stepdown, pediatric home health, NICU or pediatric nursing experience Demonstrated competence in applying processes designed to ensure adherence to all pertinent federal and state rules and regulations Sensitivity to the special needs of children who rely on technology and their families, to include understanding the stress and challenges they may experience Prior performance in meeting requirements for HRA completion, managing members with complex health care needs, and ability to manage complex workload Drivers license and access to reliable transportation Preferred Qualifications:
Experience with PDN authorizations Experience with LTSS authorizations Experience with Case Management Experience with Pediatric Home Health or Private Duty Nursing Soft Skills:
Excellent problem-solving ability, organizational skills, and capacity to work independently or as a team Excellent work ethic and attention to detail Understanding of the importance of bringing quality considerations into every touch point Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, youll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
The Private Duty Nurse Care Manager (RN) will be responsible for the overall management of a sub-population of DMAS-identified Mandatory High Priority members who must receive High Intensity care management and performing pre-service clinical reviews of Home & Community Based Services HCBS). If you reside within a commutable distance from the Central Virginia area, you will have the flexibility to work remotely* as you take on some tough challenges. *This is a field-based role that will require travel approximately 50% of the time in the field within an assigned coverage area. Candidates must be willing to travel throughout the state of Virginia; primarily in the Central Virginia area. Primary Responsibilities:
Meeting contractual requirements related to Initial HRA, MMHS Screening, ICPs, ICT, and minimum mandatory contacts Conducting face-to-face visits Oversight of PDN authorizations, including Utilization Management aspects of the authorization process Oversight of HCBS UM authorizations Participate in PDN Pod Rounds Provide primary case management across the continuum for these medically fragile and complex members to include following members through inpatient hospitalizations, assisting with transitions of care, and coordinating HCBS service needs (DME, EM/AT, PC/AC hours, and PDN hours) Serve as lead contributor to the oversight of and accountability for member-specific quality measures (HEDIS, NCQA) (will have support and assistance from Quality Department) Youll 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:
Bachelors degree in nursing Current, unrestricted RN license for the state of Virginia 1+ years of care coordination and/or work in a healthcare environment 1+ years of private duty nursing, trach, ventilator, ICU/stepdown, pediatric home health, NICU or pediatric nursing experience Demonstrated competence in applying processes designed to ensure adherence to all pertinent federal and state rules and regulations Sensitivity to the special needs of children who rely on technology and their families, to include understanding the stress and challenges they may experience Prior performance in meeting requirements for HRA completion, managing members with complex health care needs, and ability to manage complex workload Drivers license and access to reliable transportation Preferred Qualifications:
Experience with PDN authorizations Experience with LTSS authorizations Experience with Case Management Experience with Pediatric Home Health or Private Duty Nursing Soft Skills:
Excellent problem-solving ability, organizational skills, and capacity to work independently or as a team Excellent work ethic and attention to detail Understanding of the importance of bringing quality considerations into every touch point Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, youll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location and incomedeserves the opportunity to live their healthiest life. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.