Utilization Case Manager RN - In-Home Services - Milwaukee, WI

UnitedHealthcare; Milwaukee (WI); Hybrid; USD 60,000 - 107,000; Full time

Benefits offered by this job

Benefits package

Incentive programs

Equity stock purchase

401k contribution

Job summary

UnitedHealthcare is seeking a Utilization Case Manager to serve Milwaukee County with travel up to 25% to surrounding areas. The role supports a hybrid office/remote setup, requiring residency within commutable distance of Milwaukee, WI.

Responsibilities include assessing health status, home visits, coordinating care, and educating members on disease management, with collaboration from Medical Directors to optimize care plans.

Qualifications

• Current, unrestricted RN license in the State of Wisconsin
• 2+ years of experience in a hospital setting, acute care, direct care experience or experience as a Home Health Case Manager
• Basic level of experience with Microsoft Office and other electronic medical record applications
• Reliable transportation to travel to member’s homes within the geographical area
• Willing to travel up to 25% to member homes

Responsibilities

• Making outbound calls to assess members' current health status
• Conducting face to face assessments in the member’s home
• Assisting members in identifying unmet needs
• Documenting assessment details and applying State guidelines to requests for services
• Documenting and tracking findings
• Identifying gaps or barriers in treatment plans
• Providing patient education to assist with self- management
• Interacting with Medical Directors on challenging cases
• Coordinating care for members
• Making referrals to outside sources
• Coordinating services as needed (home health, DME, etc.)
• Educating members on disease processes
• Encouraging members to make healthy lifestyle changes

Skills

Microsoft Office

Travel readiness

Education

Registered Nurse (RN) license in Wisconsin

Tools

Electronic Medical Record (EMR) systems

Job description

Improve the lives of others while Caring. Connecting. Growing together.

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 Utilization Case Manager serves Milwaukee County with occasional coverage in surrounding counties. This position offers the flexibility to work from the office and at home with field-based work in the local community approximately 25% of the work week.

This role requires you to reside within a commutable distance of Milwaukee, WI and surrounding areas.

Primary Responsibilities:

• Making outbound calls to assess members' current health status
• Conducting face to face assessments in the member’s home
• Assisting members in identifying unmet needs
• Documenting assessment details and applying State guidelines to requests for services
• Documenting and tracking findings
• Identifying gaps or barriers in treatment plans
• Providing patient education to assist with self- management
• Interacting with Medical Directors on challenging cases
• Coordinating care for members
• Making referrals to outside sources
• Coordinating services as needed (home health, DME, etc.)
• Educating members on disease processes
• Encouraging members to make healthy lifestyle changes

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 license in the State of Wisconsin
• 2+ years of experience in a hospital setting, acute care, direct care experience or experience as a Home Health Case Manager
• Basic level of experience with Microsoft Office and other electronic medical record applications
• Reliable transportation to travel to member’s homes within the geographical area
• Willing to travel up to 25% to member homes

Preferred Qualifications:

• Experience in utilization review, concurrent review and / or risk management
• Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
• Experience with the Personal Care Screening Tool (PCST) or the Long Term Care Functional Screen (LTCFS)
• A background in Medicaid / Medicare managed care

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, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. #UHCPJ

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.

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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.