Maternal Child HSS Clinical Coordinator RN OR LPN - New Jersey (REMOTE)

UnitedHealth Group

Job Description

Position Description

For those who want to invent the future of health care, here is your opportunity. We're going beyond basic care coordination to health programs integrated across the entire continuum of care.

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

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.

This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. Strong computer and software navigation skills are critical. You should also be strongly member-focused and adaptable to change.

If you are located in New Jersey, you will have the flexibility to telecommute* as you take on some tough challenges managing our high risk obstetrical population.

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 or LPN license in the State of New Jersey
  • 3+ years' experience in a hospital setting, acute care, direct care experience as an RN or LPN 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
  • Proficiency with Microsoft Office Suite, with the ability to navigate a Windows environment
  • Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, Internet research, use of online calendars and other software applications

Preferred Qualifications:
  • A background in managed care
  • Medicaid experience
  • Case Management experience
  • Certified Case Manager (CCM)
  • Experience working with chronic illness and complex care needs population
  • Experience in utilization review, concurrent review and / or risk management
  • Bilingual Spanish speaking
  • Experience with HIV population
  • Psychiatric or Behavioral Health experience
  • Excellent Communication and Writing skills
  • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
  • 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

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.

Job Keywords: Registered Nurse, Nurse, RN, LPN, Licensed Practical Nurse, Quality, Quality Improvement, Analyst, Health Care, Medicaid, Medicare, HEDIS, STARS, NCQA, Managed Care, Maternal Child, Maternity, Regulatory Compliance, CMS, Provider Network Administrator, Work at Home, WAH, Work from Home, WFH, Telecommute, Telecommuter, Telecommuting, Remote, Ocean, Mammoth, Essex, NJ, New Jersey, UHC, UnitedHealthcare, Community and State, Public Sector, UHG, Middletown Township, Lakewood

Job Details

  • Requisition Number 871884
  • Job Title Maternal Child HSS Clinical Coordinator RN OR LPN - New Jersey
  • Job Family Medical and Clinical Operations
  • Business Segment Community and State

Job Location Information

  • Jersey City, NJ
    United States
    North America

Additional Job Detail Information

  • Employee Status Regular
  • Schedule Full-time
  • Job Level Individual Contributor
  • Shift Day Job
  • Travel No
  • Telecommuter Position Yes
  • Overtime Status Non-exempt

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