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

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

Job summary

UnitedHealthcare is hiring a Utilization Case Manager to serve Milwaukee County with optional coverage in surrounding areas. The role blends office and remote work with about 25% field-based visits in the local community.

The position requires an RN licensed in Wisconsin, 2+ years of relevant experience, EMR proficiency, and reliable transportation for home visits. Travel up to 25% is expected, and the salary ranges from $60,200 to $107,400 annually.

Qualifications

• Active RN license in Wisconsin.
• 2+ years of hospital/acute care or home health case management experience.
• Proficient with Microsoft Office and EMR systems.

Responsibilities

• Make outbound calls to assess members' health status.
• Conduct face-to-face assessments in the member's home.
• Identify unmet needs and coordinate care for members.
• Document assessment details and apply state guidelines to service requests.
• Track findings and identify gaps in treatment plans.
• Provide patient education for self-management.
• Interact with Medical Directors on challenging cases.
• Coordinate services such as home health and DME.

Skills

2+ years healthcare experience

Travel to member homes

Microsoft Office basic

Education

RN license Wisconsin

Tools

EMR systems

Microsoft Office

Job description

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:

• Home Health Case Management experience
• 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
• Bilingual Spanish
• Bilingual Hmong

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.