Case Manager Nurse – NCLEX – San Juan, PR

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Senior Call Center Nurse assists with organizing and initiating the work of the triage team. Coordinates staff to assure that effective nursing services are provided, and quality standards are met. The Senior Call Center Nurse is responsible for assisting and providing telephonic clinical assessments utilizing approved medical protocols per policy and recommending an appropriate level of clinical care based on clinical judgment and protocols. Staffing consists of RNs, LPNs, and customer service representatives. A multidisciplinary team approach to care is utilized. The function of the Senior Call Center Nurse is to develop and maintain an environment that supports all the staff in the nurse triage department.

This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of 9:00am – 6:00pm AST. It may be necessary, given the business need, to work occasional overtime or weekends.  Our office is located in the Montehiedra area in San Juan.

 

Primary Responsibilities: 

• Assist with coordinating and supervision of the daily activities of LPNs, RNs, and support teams
• Assist the team with digital and telephonic triage during high volume periods
• Impact of work is at the team and patient level
• Accomplishes nursing human resource objectives by selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining employees; communicating job expectations; planning, monitoring, appraising job contributions; recommending compensation actions; adhering to policies and procedures
• Meets nursing operational standards by contributing information to strategic plans and reviews; implementing production, productivity, quality, and customer-service standards; resolving problems; identifying system improvements
• Identifies patient service requirements by establishing personal rapport with potential and actual patients and other persons in a position to understand service requirements
• Assures quality of care by developing and interpreting operation and nursing division’s philosophies and standards of care; enforcing adherence to state board of nursing and state nurse practice act requirements and to other governing agency regulations; measuring health outcomes against standards; making or recommending adjustments
• Resolves patient needs by utilizing multidisciplinary team strategies
• Maintains patient confidence and protects operations by monitoring confidential information processing
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies

• Accomplishes organization goals by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments

   

   

  This is a fast-paced call center environment. Department hours of operation are 24/7 including holidays. This position will be primarily nights including some overnight hours.

   

  This is a telecommute position that requires an active Registered Nurse compact license. Candidates must be able to easily obtain additional non-compact state licenses upon request.

 

** ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION **

 

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:

• NCLEX Certification
• Current unrestricted RN licensure in applicable state
• 3+ years of healthcare experience, including experience in a managed care setting
• Case Management experience
• Experienced using Microsoft office applications, including databases, word-processing, and excel spreadsheets
• Professional proficiency in both English and Spanish (Please note that an English proficiency assessment will be required for his position)

 

Preferred Qualifications:

• Bachelor or higher degree
• RN License, current and unrestricted in Puerto Rico
• Experience in HEDIS/Star programs, preferably in a clinical quality consultant role
• Experience  in provider interactions, including provider education
• Experience with data analysis and/or quality chart reviews
• Experience influencing providers to change behavior and drive improvement in quality performance
• Experience in managed care working with network and provider relations
• Experience interacting with medical staff, peers, and internal company staff at all levels
• Experience solving process problems crossing multiple functional areas and business units
• Billing and CPT coding experience
• Call Center experience
• Clinical data abstraction experience
• Solid knowledge of the Medicare market and products
• Proven solid problem-solving skills: the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
• Proven excellent communication and customer service skills

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

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