RN Case Manager PHM Telecommute San Antonio Texas - San Antonio, TX - Case Management
Company: UnitedHealth Group
Location: San Antonio
Posted on: November 19, 2023
Job Description:
RN Case Manager PHM Telecommute San Antonio Texas - San Antonio,
TXDo 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 Nurse Case Manager II (NCM) is responsible for
patient case management for longitudinal engagement, coordination
for discharge planning, transition of care needs and outpatient
patient management through the care continuum. Nurse Case Manager
will identify, screen, track, monitor and coordinate the care of
patients with multiple co-morbidities and/or psychosocial needs and
develop a patients' action plan and/or discharge plan. They will
perform reviews of current inpatient services and determine medical
appropriateness of inpatient and outpatient services following
evaluation of medical guidelines and benefit determination. The
Nurse Case Manager will provide continuity of care for members to
an appropriate lower level of care in collaboration with the
hospitals/physician team, acute or skilled facility staff,
ambulatory care team, and the member and/or family/caregiver. The
Nurse Case Manager will coordinate, or provide appropriate levels
of care under the direct supervision of an RN Manager or MD.
Function is responsible for clinical operations and medical
management activities across the continuum of care (assessing,
planning, implementing, coordinating, monitoring and evaluating).
This includes case management, coordination of care, and medical
management consulting. Function may also be responsible for
providing health education, coaching and treatment decision support
for patients. The Nurse Case Manager will act as an advocate for
patients and their families guide them through the health care
system for transition planning and longitudinal care. The Nurse
Case Manager will work in partnership with an assigned Care
Advocate and Social Worker. If you are located in San Antonio area,
you will have the flexibility to telecommute* as you take on some
tough challenges.-- Primary Responsibilities:
- Engage patient, family, and caregivers telephonically to assure
that a well-coordinated action plan is established and continually
assess health status
- Provide member education to assist with self-management goals;
disease management or acute condition and provide indicated
contingency plan
- Identify patient needs, close health care gaps, develop action
plan and prioritize goals
- Utilizing evidenced-based practice, develop interventions while
considering member barriers independently
- Provide patients with "welcome home" calls to ensure that
discharged patients' receive the necessary services and resources
according to transition plan
- Conducts a transition discharge assessment onsite and/or
telephonically to identify member needs at time of transition to a
lower level of care
- Independently serves as the clinical liaison with hospital,
clinical and administrative staff as well as performs a review for
clinical authorizations for inpatient care utilizing
evidenced-based criteria within our documentation system for
discharge planning and/or next site of care needs
- In partnership with care team triad, make referrals to
community sources and programs identified for patients
- Utilize motivational interviewing techniques to understand
cause and effect, gather or review health history for clinical
symptoms, and determine health literacy
- Manages assessments regarding patient treatment plans and
establish collaborative relationships with physician advisors,
clients, patients, and providers
- Collaborates effectively with Interdisciplinary Care Team
(IDCT) to establish an individualized transition plan and/or action
plan for patients
- Independently confers with UM Medical Directors and/ or Market
Medical Directors on a regular basis regarding inpatient cases and
participates in departmental huddles
- Demonstrate knowledge of utilization management processes and
current standards of care as a foundation for utilization review
and transition planning activities
- Maintain in-depth knowledge of all company products and
services as well as customer issues and needs through ongoing
training and self-directed research
- Manage assigned caseload in an efficient and effective manner
utilizing time management skills
- Enters timely and accurate documentation into designated care
management applications to comply with documentation requirements
and achieve audit scores of 95% or better on a monthly basis
- Maintain current licensure to work in state of employment and
maintain hospital credentialing as indicated
- Performs all other related duties 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. Required Qualifications:
- Associate's degree in Nursing
- Current, unrestricted RN license, specific to the state of
employment or a compact nursing license
- Case Management Certification (CCM) or ability to obtain CCM
within 12 months after the first year of employment
- 3+ years of diverse clinical experience; preferred 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
- Access to reliable transportation
- 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
- Knowledgeable in Microsoft Office applications including
Outlook, Word, and Excel Ability to read, analyze and interpret
information in medical records, and health plan documents
- Bilingual (English/Spanish) language proficiency
- Bilingual (English/Vietnamese) language proficiency
- Ability to problem solve and identify community resources
- Planning, organizing, conflict resolution, negotiating and
interpersonal skills
- Independently utilizes critical thinking skills, nursing
judgement and decision-making skills
- Able to prioritize, plan, and handle multiple tasks/demands
simultaneously 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. *All
Telecommuters will be required to adhere to UnitedHealth Group's
Telecommuter Policy. 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.
Keywords: UnitedHealth Group, San Antonio , RN Case Manager PHM Telecommute San Antonio Texas - San Antonio, TX - Case Management, Executive , San Antonio, Texas
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