Private Duty Nurse - Central/Roanoke/Southwest and NOVA VA Markets

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 Private Duty Nurse (PDN) Care Manager will be the primary care manager responsible for the overall management of a sub-population of DMAS-identified Mandatory High Priority members who must receive High Intensity care management and preforming pre-service clinical reviews of Home & Community Based Services HCBS). Care Management activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care.

This is a field-based role with a home-based office that will require travel approximately 75% of the time in the field within an assigned coverage area. Candidates must be willing to travel throughout Central, Roanoke, Southwest, and Northern Virginia.

If you reside within the state of VA in Central, Southwest, Roanoke, or Nova markets, you'll enjoy the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Responsible for meeting contractual requirements related to Initial HRA, MMHS Screening, ICPs, ICT, and minimum mandatory contacts
• Conducting face-to-face visits
• Responsible for oversight of PDN authorizations, including Utilization Management aspects of the authorization process
• Responsible for oversight of HCBS UM authorizations
• Participate in PDN Pod Rounds
• Provide primary case management across the continuum for these medically fragile and complex members to include following members through inpatient hospitalizations, assisting with transitions of care, and coordinating HCBS service needs (DME, EM/AT, PC/AC hours, and PDN hours)
• Serve as lead contributor to the oversight of and accountability for member-specific quality measures (HEDIS, NCQA) (will have support and assistance from Quality Department
• Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
• Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
• Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
• Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team
• Intake of provider, care coordinator, and Continuity of Care HCBS (home and community-based service) assisted technology and environmental modifications authorization requests
• Review and processing of all HCBS service authorization requests
• Engagement with providers and initiation/follow-up on requests for information
• Engagement with the National Letters Team to complete mailing of member and provider notification of decision
• Consistent application of criteria for review and approval of provider authorization requests
• Engagement/follow-up with Medical Director to provide clinical information needed for review and application of clinical criteria
• Engagement/follow-up with Care Coordinators for assessment of member care needs
• Candidate should be a patient advocate and have tenacity for finding solution
• Candidate should have extensive knowledge of the continuum of care
• Candidate should always conduct themselves in a professional manner

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:

• Bachelor's degree in nursing
• RN Current unrestricted RN License in the State of Virginia
• 1+ years of care coordination and/or work in a healthcare environment.
• Excellent problem-solving ability, organizational skills, and capacity to work independently or as a team.
• Demonstrated competence in applying processes designed to ensure adherence to all pertinent federal and state rules and regulations
• Solid work ethic and attention to detail
• Sensitivity to the special needs of children who rely on technology and their families, to include understanding the stress and challenges they may experience
• Understanding of the importance of bringing quality considerations into every touch point
• Solid prior performance in meeting requirements for HRA completion, managing members with complex health care needs, and ability to manage complex workload

Preferred Qualifications:

• Previous experience with PDN authorizations
• Previous experience with Pediatric Home Health or Private Duty Nursing
• Previous experience in a work from home environment
• Direct experience working with HCBS authorizations and communicating with HCBS providers
• Broad knowledge of the Virginia Medicaid and/or CCC Plus program including coverage and benefits
• Utilization Management experience, including experience working with InterQual Criteria and/or Milliman Care guidelines
• Experience working with Community Care, Facets, and ICUE programs

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The hourly range for this role is $23.70 to $46.35 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with al minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.