You have high standards. So do we. Here at UnitedHealth Group, this includes offering an innovative new standard for care management. It goes beyond counseling services and verified referrals to programs integrated across the entire continuum of care. That means you'll have an opportunity to make an impact on a huge scale - as part of an incredible team culture that's defining the future of behavioral health care.
The Medically Fragile Children are those with medical fragility and/or complex medical conditions requiring significant medical or technological health supports. The Liaison shall be the direct plan contact for care coordinators and service providers, will be responsible for monitoring access to care and services, and will ensure high-touch coordination for medically fragile children.
If you are located in or close to the 5 boroughs of NY, you will have the flexibility to telecommute* as you take on some tough challenges.
Knowledge of child serving systems (education, justice, medical, welfare and child welfare), health homes and specialty providers responsible for addressing the healthcare of medically needy children, including the medically needy LOC population.
Liaison for Medically Fragile Children must support staffing and functions, and be a liaison with Health Homes and families seeking authorization of services necessary to support children in community based settings.
MFCL will be readily available via telephone and email.
Ensures utilization of necessary services to support children
Support timely authorization of HCBS services and appropriate accompanying assessments
Ensuring improved access to community resources and improvement of overall health status
Liaison to UM team regarding requirements for medically fragile population set forth by “Office of Health Insurance Programs Principles for Medically Fragile Children”
Support/assist families in management of grievances, appeals and denials requested by medically fragile children
Case management of clinical services and DMEs requested by medically fragile children
Able to review and advise on Plans of Care for medically fragile children
Liaison to UM team regarding review and approvals of Plans of Care and authorizations of HCBS services
Provide clinical guidance and supervision to assigned CM in order to promote efficient and effective delivery of clinical management services.
Supervise the case management workflow including case selection, interventions and goal setting, follow-up/follow-through activities, documentation and escalations.
Ensure clinical management activities are conducted in a safe, efficient and effective manner to promote continuity and quality of care.
Perform ongoing quality review of cases to ensure accuracy and compliance.
Identify and report potential risk, operational opportunities and barriers encountered in the day to day operations, proactively share with the leadership team.
Actively participate in staff training and meetings.
Develop and maintain collaborative relationships with Health Home care coordinators, HCBS and clinical providers, facility staff and community resources.
You'll find the pace fast and the challenges are ongoing. You'll be expected to document and achieve measurable results. You'll also need to think and act decisively while working with a diverse member population.
Must have an active, unrestricted State of New York RN license
Minimum of 5 years-experience as a pediatric nurse or experience with Care at Home/ Medically Fragile Children / Private Duty Nursing
Proficiency with computers, MS Office, Word, Excel, Powerpoint, Outlook, navigating in multiple systems and web based applications
Strong verbal and written communication skills including motivational coaching, influencing and negotiation abilities
Excellent time management and organizational skills, strong problem solving
Ability to prioritize and manage changing priorities under pressure
Must live in or close to King’s County and be able to travel within the 5 boroughs
Master’s degree in Nursing
ANP Preferred (Adult Nurse Practitioner)
UM or CM experience in a health care and/or Managed Care setting
We can provide you with meaningful challenges that can result in a strong sense of impact and fulfillment. Reach for more and discover your life's best work.(sm)
Diversity creates a healthier atmosphere:
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.
RN, Registered Nurse, Work at home, Medically Fragile Children, Telecommute, Brooklyn, NY