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

About the role

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.

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

Requirements

• 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

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

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution
• All benefits are subject to eligibility requirements

Pay

The salary for this role ranges from $60,200 to $107,400 annually (full‑time). Pay is based on factors including local labor markets, education, work experience, certifications, etc.

Schedule

• Flexibility to work from the office and at home with field‑based work in the local community approximately 25% of the work week
• Must reside within a commutable distance of Milwaukee, WI and surrounding areas