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.

Are you ready for your next challenge? Discover it here at UnitedHealth Group and help us reinvent the health system. We're going beyond basic care, providing integrated health programs with a member-centric focus. The challenge is ensuring we deliver the right care at the right time. When you join us as a RN Case Manager, you'll be making a difference in peoples' lives by offering support and assistance to members seeking health education, program referrals or general health services. You will work with patients to manage their health conditions for ultimate outcomes by taking in-bound calls and placing out-bound calls as dictated by consumer and business needs. You will also be working with clients who are recently released from incarceration, assessing their healthcare needs and assisting them in accessing the appropriate care.

This is a 40 hours per week position. 30 hours of the week is spent at the Community Transitional Center in the Rosecrans area of San Diego, where you will review medical records of clients scheduled for release from jail and also assist with case management of those living at the Community Transitional Center. 10 hours per week is spent working from home where you will review prior authorization and pharmacy requests for the San Diego County Medical Services Program.

Location will be at customers office. Community Transition Center (CTC3880 Rosecrans St, San Diego, CA 92110)

Primary Responsibilities:

• Assess, plan, implement, coordinate, monitor, and evaluate case management activities for offenders being released from state and local prison and for those currently residing at the Community Transition Center, across the continuum of care, within the scope of the case manager's license
• Coordination and service delivery, Physical and psychological factors, Case management concepts and Community resources. Perform pre-release planning for men and women coming out of the prison system
• Provide knowledge to probation officers regarding difficult medical cases. Meet with clients who are currently residing at the Community Transition Center for ongoing medical case management
• Understand and maintain confidentiality of legal and ethical issues at all times
• Check eligibility as per procedure/ client specifications; if there is an eligibility problem, the case manager notifies the caller and consults the case management supervisor
• Assess initial clinical information and develop a treatment plan and goals that meet the individual patient's/ client's present needs
• Communicate goals and objectives to all pertinent parties
• Evaluate and certify all cases for potential complications, and cases that would benefit from alternative care
• Assess clinical information at established intervals to evaluate the effectiveness of the case management plan for each patient
• Evaluate and communicate the case objectives and goals to the individual patient's case management team. Consult physician advisers to determine the medical necessity and appropriateness of treatment plan goals and objectives
• Maintain an open line of communication with all parties of the individual case management treatment team to include patient, probation officer, and other service providers across the continuum of care
• Remain aware of and follow all departmental policies and procedures. Answer calls as needed for individual assigned units. Assume other duties as assigned and directed by the case management or other supervisors. Report any quality issues identified to the case management supervisor

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 licensure in CA
• 2 years of RN experience, resulting in excellent clinical skills and judgment

• 2 years of case management experience

• Effective inbound and outbound telephonic skills
• Intermediate computer skills (Microsoft Word, Outlook and Internet) with the ability to navigate a Windows environment and the ability to create, edit, save and send documents utilizing Microsoft Word
• Proficiency in assessment of needs and the ability to influence and motivate
• Conflict management skills
• Able to work under pressure and appropriately prioritize responsibilities

Preferred Qualifications:

• Bachelor's degree in Nursing
• Case management certification (CCM)
• Understanding of Case Management and Care Coordination
• Coaching and / or decision support experience
• Managed care experience

California Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.