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    RN Clinical Tribal Coordinator - Phoenix, United States - UnitedHealthcare

    UnitedHealthcare
    UnitedHealthcare Phoenix, United States

    2 weeks ago

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    Description

    Welcome to UnitedHealthcare! We are dedicated to simplifying the healthcare experience, fostering healthier communities, and breaking down barriers to quality care. Your work with us directly impacts millions of lives for the better. Join us in shaping the future of healthcare, making it more responsive, affordable, and equitable. Are you ready to make a meaningful difference? Come be a part of Caring, Connecting, and Growing together.

    The Clinical Tribal RN Care Manager plays a crucial role in managing and coordinating care for Tribal members. This position involves collaborating with members, providers, facilities, and other entities to ensure the delivery of the most suitable care. The Care Manager oversees members across all contracted lines of business.

    Responsibilities of the Care Manager include assessing, planning, implementing, and monitoring individualized care plans in compliance with NCQA guidelines. The goal is to optimize the utilization of options and services to meet the health needs of each member effectively. Additionally, the Care Manager provides advocacy, communication, resource management, and promotes quality, cost-effective interventions, and outcomes.

    The ideal candidate for this position is a licensed RN in good standing in Arizona, a member or affiliate of a tribe, or has experience working directly with IHS, Tribes, Tribal Organizations, Urban Indian Organizations within a healthcare setting in the Phoenix area.

    If you are based in Arizona, you will have the opportunity to work remotely* while tackling challenging tasks. Travel within Arizona is required 60% of the time.

    Primary Responsibilities:

    • Care Management allocation:
      • Care Management responsibilities: 80% allocation involving case consultations with a caseload of 45-50
      • Utilization of internal resource tools to identify at-risk AI members
      • Community, relationship building, education: 20% (Efforts to be logged and tracked, with objectives, goals, outcomes, and changes reviewed with Manager)
    • Understand and support the needs of the plan's Tribal members in a culturally competent and respectful manner
    • Familiarity with Tribal customs, laws, and healthcare requirements
    • Seek feedback from the Tribal community for quality improvement purposes
    • Establish strong collaborative relationships with community organizations to address and resolve issues
    • Provide care management support for individuals with disabilities
    • Assess needs using a standardized process
    • Develop service plans, coordinate with primary providers, and ensure culturally competent care
    • Support tribal membership with care coordination for medical, behavioral, and social health services
    • Assist members in engaging with providers, coordinate service delivery, and provide information on culturally appropriate care and resources
    • Create collaborative relationships with IHS, Tribes, Tribal Organizations, Urban Indian Organizations
    • Monitor data, identify trends related to American Indian members, and evaluate processes for increased efficiency and productivity
    • Update tribal documents and reports, collaborate with relevant organizations to enhance communication and care coordination for American Indian members
    • Identify barriers in delivering physical and behavioral health services to the American Indian population
    • Coordinate with health plan coordinators for member care
    • Provide training on best practices and clinical requirements to staff
    • Utilize existing technological infrastructure for telemedicine and telepsychiatry

    You will be recognized and rewarded for your performance in a challenging environment that provides clear direction for success in your current role and opportunities for development in other areas of interest.

    Required Qualifications:

    • Registered Nurse with an active AZ license
    • 5+ years of experience as a care manager/utilization manager
    • 4+ years of community healthcare experience
    • Experience working remotely and proficiency in Microsoft Office Suite
    • Affiliated or experienced with IHS, Tribes, Tribal Organizations, Urban Indian Organizations
    • Proficiency in various technologies and platforms

    Preferred Qualifications:

    • Experience with AZ Medicaid
    • Background in long-term care, home health, hospice, public health, or assisted living
    • Experience with complex medical conditions and co-morbidities
    • Expertise in problem-solving, option evaluation, and solution implementation
    • Knowledge in Diabetes Disease management and education

    Soft Skills

    • Strong verbal and written communication skills
    • Ability to prioritize, plan, and multitask effectively
    • Self-directed and independent

    *All remote employees must adhere to UnitedHealth Group's Telecommuter Policy.

    At UnitedHealth Group, our mission is to improve health outcomes and make healthcare accessible to all. We believe in providing equitable care that addresses health disparities and promotes healthy living for everyone. Join us in our commitment to diversity and inclusivity as we work towards a healthier future for all.

    Diversity enriches our workplace: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer. All qualified applicants will be considered without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity, marital status, genetic information, or any other characteristic protected by law.

    UnitedHealth Group maintains a drug-free workplace. Candidates must pass a drug test before starting employment.

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