Private Duty Nurse Care Manager – Remote In Central Va

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. 

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 preforming 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. 

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)

**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.***

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:

• Bachelor’s 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

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
  

*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.