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Registered Nurse Outpatient Case Manager Healthcare WellMed San Antonio TX

Company: UnitedHealth Group
Location: Karnes City
Posted on: November 25, 2022

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve -your life's best work.(sm)
The primary responsibility of the OP Case Manager is to identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a case management care plan. They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers, educators, health care coordinators/managers. The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence. The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions. The Case Manager may perform telephonic and/or face-to-face assessments.
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Primary Responsibilities:


  • Independently conducts initial assessments within designated timeframes for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
  • Collaborates effectively with IDT to establish an individualized care plan for members with interventions to assist the member in meeting short- and long-term goals
  • Engages patient, family, and caregivers to assure that a well-coordinated care plan is established
  • Identifies member needs, develop care plan and prioritize goals; using evidence-based practice the Case Manager will develop interventions while considering member barriers independently
  • Makes outbound calls to assess member health status, identify gaps or barriers in care plan
  • Provides member education to assist with self-management goals
  • Makes referrals to outside sources
  • Educates members on disease process or acute condition and provide indicated contingency plan
  • Coordinates visits with PCP and specialists as needed on a limited basis, performs visual assessment for skin checks on exposed skin, and conducts home safety evaluation
  • Independently confers with Market MD Medical Directors and/or PCPs on a regular basis regarding Complex Care/High Risk Population members and participates in department huddles
  • Enters timely and accurate data into designated care management applications and maintains audit scores of 95% or better monthly
  • Adheres to organizational and departmental policies and procedures
  • The Case Manager will also maintain current licensure to work in state of employment. Decision making is based on regulatory requirements, policies and procedures, and current clinical guidelines

    • Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms


    • Monitors for quality concerns regarding member care and reports as per policy and procedure -
    • Performs all other related duties as assigned

      Full-Time Hybrid-IH10W/Office/Field Base Position: -This position requires 25% - 50% traveling around the San Antonio, TX, and counties areas: Coordinating weekly visits with PCP and specialists as needed on a limited basis, performing visual assessment for skin checks on exposed skin, and conducts home safety evaluation.
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      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:

      • Associate's degree in Nursing
      • Current unrestricted Registered Nurse license, specific to the state of employment -
      • Case Management certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
      • 3+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
      • 3+ years of managed care and/or case management experience
      • Knowledge of utilization management, quality improvement and discharge planning -
      • Demonstrated ability to read, analyze, interpret information in medical records and health plan documents
      • Demonstrated ability to problem solve and identify community resources
      • Experience utilizing planning, organizing, conflict resolution, negotiating and interpersonal skills
      • Experience utilizing critical thinking skills, nursing judgement and decision-making skills; Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously
      • Proficient with Microsoft Office applications including Outlook, Word, and Excel
      • Ability to stand, walk or sit for long periods
      • Access to reliable transportation
      • This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
      • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

        Preferred Qualifications:

        • Experience working with psychiatric and geriatric patient populations

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          To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
          Careers with WellMed. -Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do -your life's best work.(sm)
          WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
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          Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
          OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, San Antonio , Registered Nurse Outpatient Case Manager Healthcare WellMed San Antonio TX, Executive , Karnes City, Texas

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