RN Field Case Manager - Maternal Health - Remote in Lexington, KY

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.

What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

As a Maternal Health RN, you will act in a clinical liaison role with Medicaid members to ensure appropriate care is accessed as well as to provide home and social assessments and member education. The RN works in a team-based structure and spends 25% of their time in the community engaging directly with members. You will work with medically complex patients who may be experiencing significant addiction and/or behavioral health conditions is important for this role.

This is high volume, customer centric environment. You'll need to be efficient, productive and thorough dealing with our members over the phone and in person. Solid computer and software navigation skills are critical.

If you are located in or within commutable driving distance to Lexington, Paris, Nicholasville, and/ or Carlisle, KY, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Making outbound calls to assess members' current health status
• Manage highly complex members as part of an inter-disciplinary care team approach in collaboration with Care Coordinators (CCs), Community Health Workers (CHWs), OB providers, behavioral health providers, etc.
• Consult with care team to address specialty care services, community-based resources, and other member complex care needs
• Assist in identification of pregnant women and children including those with special health care needs and access/linkages to appropriate care
• Working with the complex maternity care needs
• Identifying gaps or barriers in treatment plans
• Providing patient education to assist with self-management
• Interacting with Medical Directors, providers, internal and external partners on challenging cases
• Coordinating care for high risk maternity members
• Making referrals and connecting members to community resources
• Coordinating services as needed (home health, DME, etc.)
• Educating members on disease processes
• Educating members on (e.g. inter-conception care, chronic condition management, smoking cessation, safe sleep for infants, breast feeding advantages, substance use avoidance, etc.)
• Encouraging members to make healthy lifestyle changes
• Documenting and tracking findings