Clinical Care Manager (CCM), RN - Remote

Clinical Care Manager (CCM)

At United Healthcare, 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

CCMs are RNs who serve as a key member of the United Healthcare Global Emergency Response and Assistance Center Team and utilize evidenced based practice to assess global traveler's medical care needs, treatment plans of healthcare providers and the ability of the local healthcare systems to provide appropriate quality and cost effective care when acute, chronic or catastrophic events occur in countries around the world.

CCMs evaluate, recommend and monitor patient status and associated treatment plans to ensure complex medical cases are managed to the highest level of quality and patient safety. CCMs coordinate with appropriate providers and assist in establishing and implementing plans including but not limited to a patient's medical monitoring, return home, and safe evacuation to a location where appropriate care is available when it's determined the care needs cannot be met in the current location.

Services may also include support for travelers into the USA with complex treatment needs, appointment arrangement, receiving facility acceptance, clinical case management, client updates, and discharge planning in support of their return to their home country after care.

CCMs establish a good relationship with the hospital, nurses, doctors, and social workers gaining their trust and respect to facilitate the collection of information and improve the image of the company and patient care. CCMs document all conversations with providers and physicians, medical records review and any patient care related phone call to ensure information is available to all team members for continuity and care management.

The CCM identifies and escalates potentially fraudulent activities identified during the pre-authorization evaluation process. Complex and high-cost cases are uniquely reported, monitored and supported through the collaboration with all members of the Emergency Response and Assistance Team to include Medical Directors, Global Care Consultants, and Healthcare Intelligence team members to facilitate seamless provision of healthcare services to those we serve.

*** Candidates must be available to work 8-to-12-hour shifts including every other weekend and holidays as dictated by needs of business in a 24/7 environment ***

You'll enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Managing global assistance cases
• Collaborating with interdisciplinary team members (eg: logistical and healthcare intelligence) as appropriate on case work
• Collaborating with Medical Directors and Physician Advisors when appropriate
• Triage global medical cases, complete clinical assessment and communication of case direction to the logistics specialists to facilitate the necessary evacuation or continued monitoring of care being provided locally
• Works collaboratively with international and domestic healthcare providers and internal colleagues to assure appropriate high quality cost-effective care management, proactive discharge and medically safe travel planning, optimize patient health
• Participates in the management of complex medical cases and collation of clinical information to assess and expedite assessment of care needs. This includes obtaining and reviewing verbal and written medical reports / records as well as communicating directly with the treatment facilities and providers
• Engages in provider and facility quality assurance review as determined by business need
• Other duties/projects as assigned

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.

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