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 Clinical Tribal RN Care Manager will be responsible for the care management and coordination of identified Tribal members. This position works directly with the member, provider(s), facilities, and other entities to ensure the most appropriate care is provided. The Care Manager manages members from all contracted lines of business.

The Care Manager assesses, plans, implements, coordinates, monitors, creates an individualized care plan meeting NCQA guidelines and evaluates the outcomes, ensuring options and services required to meet the member's health needs are best utilized. The Care Manager provides advocacy, communication and resource management and promotes quality and cost-effective interventions and outcomes.

This position is a licensed RN in good standing within the state of AZ, a member or affiliate of a tribe, or experience working directly with IHS, Tribes, Tribal Organizations, Urban Indian Organizations (I/T/U) in a healthcare setting and located within the Phoenix area.

If you are located in Arizona, you will have the flexibility to work remotely* as you take on some tough challenges. Travel is required 60% of the time in Arizona.

Primary Responsibilities:

• Care Management allocation:
• Care Management responsibilities: 80%-time allocation which includes case consultations with a case load of 45-50
• Utilization of hotspotting tool and other internal resource tools that identify at risk AI members
• Community, relationship building, education: 20% (Interventions and efforts to be logged and tracked, reviewed with Manager, including objectives, goals, outcomes, changes)
• Understand the needs of the plan's Tribal members and offer support in a culturally competent and respectful manner
• Be familiar with Tribal customs, laws, and health care needs
• Solicits feedback from the Tribal community for quality improvement purposes
• Builds strong collaborative relationships with community organizations to identify and resolve issues
• Provides care management support for persons with disabilities (EPD and DDD ALTCS members)
• Assesses needs using a standardized process
• Develops service plan to put services in place and coordinates with primary providers
• Ensures culturally competent care/case management
• Provide care management support to tribal membership, and, for the purposes of care coordination for medical, behavioral, and social determinants of health services
• Assist members in establishing/engaging with providers
• Coordinate service delivery for members receiving services at Indian Health Services (IHS) or 638 Tribal Facilities
• Provides information, assistance, & help in finding culturally appropriate care and resources
• Support/develop collaborative relationships with IHS, Tribes, Tribal Organizations, Urban Indian Organizations (I/T/U) serving tribes in its assigned GSA(s)
• Monitor data and identify trends related to American Indian members, including but not limited to quality of care, access, timeliness, and availability of services
• Evaluate clinical processes and suggest revisions to increase productivity and efficiency
• Support and update annual tribal documents
• Update any ad hoc reports from AHCCCS/DDD
• Collaborate with AHCCCS and DDD, IHS and 638 Tribal Facilities to improve communication through the utilization of health information exchange (HIE) to improve coordination of care and health outcomes for American Indian members
• Identify barriers associated with physical and behavioral health service delivery to the American Indian population
• Coordinate with the health plan court coordinators for members on COT/COE
• Provide training and education on best practices and general clinical requirements to tribal and Health Plan staff
• Collaborate with tribes to utilize existing technological infrastructure for telemedicine and tele-psychiatry.

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:

• Registered Nurse, active AZ license
• 5+ years of experience as a care manager/utilization management helping individuals with physical/behavioral health needs
• 4+ years of experience working within the community health setting in a health care role
• Experience working remotely
• Experience with Microsoft Office Suite including Word, Excel, Outlook, and PowerPoint
• Affiliated or member of a tribe, or experience working directly with IHS, Tribes, Tribal Organizations, Urban Indian Organizations (I/T/U) in a healthcare setting
• Experience with varying technology and platforms

Preferred Qualifications:

• AZ Medicaid Experience
• Experience in long-term care, home health, hospice, public health or assisted living treatment setting
• Experience working with individuals with multiple co-morbidities and complex medical conditions
• Experience identifying complex problems and reviewing related information to develop and evaluate options and implement solutions
• Diabetes Disease case management and/or educator

Soft Skills

• Excellent verbal and written communication skills; ability to speak clearly and concisely, convey complex or technical information in a manner that others can understand and interrelate with individuals at various levels
• Self-directed - Independent
• Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously

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

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.