RN Case Manager - LHI World Trade Center Health Program - La Crosse, WI Office
At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone
LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well-being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.
LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on-location services, patient-specific in-clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work.(sm)
We are currently seeking an Case Manager, World Trade Center. This Case Manager, World Trade Center will be responsible for assessing and coordinating care for a very diverse population of members of the World Trade Center (WTC) National Responder Health Program throughout the United States. Additionally, this role will educate and inform members of program coverage and limitations while ensuring that high quality and cost-effective care is provided within contract requirements. The ideal candidate will be able to use critical thinking and problem solving skills to navigate through the complexities of a member’s health conditions while maintaining coverage within the program guidelines. Coordinate health care services for members. The Case Manager will prepare and summarize medical history information on members to present to the Medical Director. Additionally this role is critical in cultivating relationships with members, providers, co-workers, and other team members to ensure program compliance and member satisfaction.
- Maintain an ongoing responsibility for assigned caseload which entails assessment, education and coordination of care for members/health care providers throughout the United States via telephone while keeping a detailed medical record within internal database. Establish and maintain regular contact with members, providers and department supervision.
- Manage inbound and outbound calls from providers to prior authorize tests and procedures related to a members certified health conditions and program coverage.
- Review medical records (monitoring, treatment and supportive) to determine WTC relatedness for potential program coverage and communicate results of the review to the members; If review of medical records is inconclusive, communicate with the Medical Director who will make the final decision on coverage to be communicated to the member by the Case Manager.
- Completion of system generated tasks, including documenting all results as required.
- Prepare comprehensive reviews and summaries for medical appeals, determination of coverages and requests for treatment services.
- Point of contact for internal departments to answer questions relative to members of their assigned caseload.
- Completion of medical health questionnaires in times of reduced coverage.
***THIS POSITION IS NOT ELIGIBLE FOR TELECOMMUTERS - CANDIDATES MUST RESIDE IN / AROUND THE LA CROSSE, WI AREA, OR ABLE TO RELOCATE***
Please Note: In order to be considered for this position, you must be able to obtain an SF86 Position of Trust which is only available to U.S. Citizens. Our Facilities Security Officer will initiate this process post-offer acceptance. Failure to obtain this will result in termination from this role.
- Graduate of an accredited Associate’s Degree in Nursing (ADN) or Bachelor’s Degree in Nursing (BSN) program
- Current RN license in the state in which you are practicing
- Minimum of four years of clinical experience
- Proficient computer skills with Microsoft Office Suite experience
- Ability to work independently as well as on a team
- Med Surg and/or Med Surg with Oncology experience highly preferred
- Case Management experience, behavioral health, occupational health or medical/surgical background
- Previous military healthcare experience
- Medical call center experience or medical related experience in a corporate/business setting
- Excellent verbal and written communication skills including strong telephone etiquette and interpersonal skills with individuals at all levels of an organization
- Knowledge of ICD and CPT coding
- URAC/ISO experience/knowledge
- National Career Readiness Certificate
- Demonstrated ability to adapt to performing a variety of duties, changing from one task to another of a different nature, without a loss of efficiency or composure
- Must be able to implement critical thinking and decision making skills in order to identify appropriate care/treatment plans for a wide range of members from low to high complexity
- Must have the ability to take initiative and be detail-orientated in a goal-orientated environment.
- Equivalent combination of education, experience and/or applicable military experience will be considered.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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