RN Nurse Manager Case Management San Antonio, TX
Company: Optum
Location: San Antonio
Posted on: June 2, 2025
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Job Description:
WellMed, part of the Optum family of businesses, is seeking a RN
Manager Care Management to join our team in San Antonio, TX. Optum
is a clinician-led care organization that is changing the way
clinicians work and live.
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As a member of the Optum Care Delivery team, you'll be an integral
part of our vision to make healthcare better for everyone.
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At Optum, you'll have the clinical resources, data and support of a
global organization behind you so you can help your patients live
healthier lives. Here, you'll work alongside talented peers in a
collaborative environment that is guided by diversity and inclusion
while driving towards the Quadruple Aim. We believe you deserve an
exceptional career, and will empower you to live your best life at
work and at home. Experience the fulfillment of advancing the
health of your community with the excitement of contributing new
practice ideas and initiatives that could help improve care for
millions of patients across the country. Because together, we have
the power to make health care better for everyone. Join us and
discover how rewarding medicine can be while Caring. Connecting.
Growing together
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The Manager of Case Management is responsible for facilitating
communication and directing the operations of all Case Management
programs in a defined market. -The Manager leads the market staff
on all activities related to medical management initiatives
including changes in process, staffing or care delivery model.
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Additionally, the manager ensures compliance with all state/federal
regulations and NCQA/URAC standards. -The Manager collaborates with
the Regional Director of Case Management, medical directors, PCPs,
clinic and corporate medical management leadership on care
coordination activities.
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Primary Responsibilities:
Supports case management operations across the continuum of care
(assessing, planning, implementing, coordinating, monitoring, and
evaluating)
Oversees care management functions and ensure compliance with
application of criteria from approved standardized guidelines,
government mandated regulations and contractual agreements, to
include NCAQ, URAC, and CMS
Engages in Care Team forums/meetings to support care coordination
activities between the market providers and the case management
team
Plans, organizes and oversees staff to ensure timely completion of
um determinations, discharge planning and case management
assessments
Ensures team meets established performance metrics and medical cost
reduction goals. Includes timely reporting of monthly KPIs
Adapts departmental plans and priorities to address business and
operational challenges
Oversees the team's daily staffing requirements to meet program
standards
Implements and interprets organizational policies and procedures,
reviews work of staff to ensure that policies and guidelines are
appropriately applied -
Tracks and trends outcomes for potential improvements in the care
management process. -Creates monitors, evaluates and disseminates
program and productivity reports weekly, monthly, and as needed
Interviews, hires, and retains staff to meet the needs of the
department
Evaluates staff performance and recommend merit increases,
promotions, and disciplinary actions
Attends, and assists with the facilitation of local market
-intra-disciplinary care team meetings
Monitors and oversees the reporting of all quality issues to
medical management leadership for referral and reporting to health
plans as appropriate
Monitors appropriate utilization of resources, overtime, supplies
and mileage
Perform comprehensive assessments and document findings in a
concise/comprehensive manner that is compliant with documentation
requirements and Center for Medicare and Medicaid Services (CMS)
regulations
Performs all other related duties as assigned
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In 2011, WellMed partnered with Optum to provide care to patients
across Texas and Florida. WellMed is a network of doctors,
specialists and other medical professionals that specialize in
providing care for more than 1 million older adults with over
16,000 doctors' offices. At WellMed our focus is simple. We're
innovators in preventative health care, striving to change the face
of health care for seniors. WellMed has more than 22,000+ primary
care physicians, hospitalists, specialists, and advanced practice
clinicians who excel in caring for 900,000+ older adults. Together,
we're making health care work better for everyone.
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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:
Bachelor of Science in Nursing (BSN) (4+ years of experience beyond
the years of experience may be substituted in lieu of a bachelor's
degree)
Current unrestricted Texas RN License
CCM certification or proof that certification has been obtained
within one year of hire date
5+ years of healthcare experience to include experience in a
managed care setting, hospital setting and/or physician practice
setting
3+ years of demonstrated supervisory or management experience with
responsibility for team performance management -
Solid experience with MS office including Word, Excel and Outlook
with proficient ability to navigate in a Windows environment -
Proven ability to establish and maintain effective working
relationships with employees, managers, healthcare professionals,
physicians and other members of senior administration and the
general public
Proven data mining, analytical and reporting skills. -Must be able
to review and interpret data to make recommendations to
senior-management
Demonstrates solid organizational skills and multitasking
abilities
Ability to travel in and /or out-of-town as deemed necessary by
business need
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
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Preferred Qualifications:
Master's Science in Nursing
Multi-site regional operations management responsibility
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Physical & Mental Requirements: -
Ability to sit for extended periods of time
Ability to use fine motor skills to operate office equipment and/or
machinery
Ability to receive and comprehend instructions verbally and/or in
writing
Ability to use logical reasoning for simple and complex problem
solving
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The salary range for this role is $71,600 to $140,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
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OptumCare -is an Equal Employment Opportunity employer under
applicable law and qualified applicants will receive consideration
for employment without regard to race, national origin, religion,
age, color, sex, sexual orientation, gender identity, disability,
or protected veteran status, or any other characteristic protected
by local, state, or federal laws, rules, or regulations.
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OptumCare -is a drug - free workplace. Candidates are required to
pass a drug test before beginning employment.
Keywords: Optum, San Antonio , RN Nurse Manager Case Management San Antonio, TX, Executive , San Antonio, Texas
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