Case Manager - Nurse (RN) / Pediatric Experience Required!!!

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.AmeriChoice, a UnitedHealth Group company, is a recognized leader and innovator in providing managed health care solutions to its membership, which includes Medicaid, Medicare and SCHIP beneficiaries.  With over a decade of growth and success, we are poised for continued expansion of our services in this dynamic marketplace. Our commitment to this specialized market makes a genuine difference in the lives of our 1.8 million members. Join us, do rewarding work, and build a great career.  The primary purpose of this position is to coordinate member care needs across the continuum beginning with early identification of health risk factors, education, and prevention to assure the provision of appropriate services in acute, home, chronic and alternative care settings, to meet their needs in the most cost-effective manner available.  Engage enrollee, identify and stratify needs through initial assessment Develop, implement, maintain and evaluate an individual care plan when services are indicated, based on member needs identified through proactive collaboration and communication with members, families and other caregivers. Collaborate and communicate with other members of the Care Coordination Team to improve the quality and efficiency of health care delivery and assure smooth transition of care coordination activities to other team members. Provide education and coordination of community resource referrals to members and providers Monitor hospital encounters of assigned members and provide education and/or interventions as necessary to reduce frequency. Participate in the Plan Quality Improvement process include recognition of quality of care issues and forward information to appropriate staff for review and resolution. Maintains time sensitive documentation utilizing plan software to enter service requests, document and monitor all aspects of patient care coordination and service delivery. Refer clinical decisions beyond level of authority for members who do not meet established criteria to Supervisor and/or Team Leader for review and decision. Perform other duties as assigned The candidate must posses:  Current Unrestricted nursing license in the state of RI 3-5 years related clinical experience with pediatric patients Proficient computer skills Strong problem solving and decision making abilities Organize work and develop strategies for adapting to a constantly changing workload or when confronted with unforeseen situations Ability to function independently with minimal supervision Demonstrate initiative in achieving individual, team, and organizational goals and objectives Act as an advocate for enrollee Maintain direct and open communication within all levels of the organization Able to handle sensitive and confidential information according to HIPAA and UHG regulations Demonstrate cultural competence and sensitivity Excellent organization, communication and time management skillsWe would also prefer: Bilingual in English and Spanish Working knowledge of Medicare/Medicaid regulations Case Management experience Experience in a managed care environmentUnitedHealth Group offers a full range of comprehensive benefits to full-time and part-time employees, including medical, dental and vision, as well as a matching 401k and an employee stock purchase plan.   UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment   Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.