19 days old

RN Case Manager - LaCrosse, WI or Central Time Zone Preferred

La Crosse, WI 54601
  • Job Code

At Optum, the mission is clear:  Help people live heathier lives and help make the health system work better for everyone


LHI is one of 4 businesses under OptumServeOptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans.  By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.


LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.


There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work. (sm)


As a RN Case Manager, you can assess and coordinate care for a very diverse population of members of the World Trade Center (WTC) Health Program throughout the United States. This is a multifaceted role that is highly rewarding as your work is helping people live healthier lives.


The hours for this position are Monday through Friday, 9:00 am - 6:00 pm CST.


Primary Responsibilities:


  • Educate and inform members of program coverage and limitations while ensuring that high quality and cost-effective care is provided within contract requirements
  • Use critical thinking and problem solving skills to navigate through the complexities of a member's health conditions while maintaining coverage within the program guidelines
  • Coordinate health care services for members
  • Prepare and summarize medical history information on members to present to the Medical Director
  • Cultivate relationships with members, providers, co-workers, and other team members to ensure program compliance and member satisfaction
  • Manage an assigned caseload which entails assessment, education and coordination of care for members/health care providers throughout the United States telephonically while keeping a detailed medical record within internal database. Establish and maintain regular contact with members, providers and department supervision
  • Manage inbound and outbound calls from providers to prior authorize tests and procedures related to members' certified health conditions and program coverage
  • Review medical records (monitoring, treatment and supportive) to determine WTC relatedness for potential program coverage and communicate results to members
  • Completion of system generated tasks, including documenting all results as required in internal database (MedNet)
  • Prepare comprehensive reviews and summaries for medical appeals, determination of coverages, and requests for treatment services
  • Point of contact for internal departments to answer questions relative to members of their assigned caseload
  • Completion of medical health questionnaires in times of reduced coverage


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.



Posted: 2020-10-06 Expires: 2020-11-14

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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RN Case Manager - LaCrosse, WI or Central Time Zone Preferred

UnitedHealth Group
La Crosse, WI 54601

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