Registered Nurse Renal Case Manager Telecommute Texas - San Antonio, TX - Gastroenterology
Company: UnitedHealth Group
Location: San Antonio
Posted on: January 27, 2023
Job Description:
Registered Nurse Renal Case Manager Telecommute 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 the state of Texas, you will have the flexibility to
work remotely* 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 Preferred Qualifications:
- Experience working with psychiatric and geriatric patient
populations
- Bilingual (English/Spanish) OR (English/Vietnamese) --language
proficiency
- Knowledgeable in Microsoft Office applications including
Outlook, Word, and Excel Ability to read, analyze and interpret
information in medical records, and health plan documents
- Ability to problem solve and identify community resources
- Possess planning, organizing, conflict resolution, negotiating
and interpersonal skills
- Independently utilizes critical thinking skills, nursing
judgement and decision-making skills
- Ability to prioritize, plan, and handle multiple tasks/demands
simultaneously 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
employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy At UnitedHealth Group, our
mission is to help people live healthier lives and make the health
system work better for everyone. We believe everyone-of every race,
gender, sexuality, age, location and income-deserves the
opportunity to live their healthiest life. Today, however, there
are still far too many barriers to good health which are
disproportionately experienced by people of color, historically
marginalized groups and those with lower incomes. We are committed
to mitigating our impact on the environment and enabling and
delivering equitable care that addresses health disparities and
improves health outcomes - an enterprise priority reflected in our
mission. -- -- -- 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. OptumCare is a drug-free
workplace. Candidates are required to pass a drug test before
beginning employment. 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 Preferred Qualifications:
- Experience working with psychiatric and geriatric patient
populations
- Bilingual (English/Spanish) OR (English/Vietnamese) --language
proficiency
- Knowledgeable in Microsoft Office applications including
Outlook, Word, and Excel Ability to read, analyze and interpret
information in medical records, and health plan documents
- Ability to problem solve and identify community resources
- Possess planning, organizing, conflict resolution, negotiating
and interpersonal skills
- Independently utilizes critical thinking skills, nursing
judgement and decision-making skills
- Ability to prioritize, plan, and handle multiple tasks/demands
simultaneously 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
employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy At UnitedHealth Group, our
mission is to help people live healthier lives and make the health
system work better for everyone. We believe everyone-of every race,
gender, sexuality, age, location and income-deserves the
opportunity to live their healthiest life. Today, however, there
are still far too many barriers to good health which are
disproportionately experienced by people of color, historically
marginalized groups and those with lower incomes. We are committed
to mitigating our impact on the environment and enabling and
delivering equitable care that addresses health disparities and
improves health outcomes - an enterprise priority reflected in our
mission. -- -- -- 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. OptumCare is a drug-free
workplace. Candidates are required to pass a drug test before
beginning employment.
Keywords: UnitedHealth Group, San Antonio , Registered Nurse Renal Case Manager Telecommute Texas - San Antonio, TX - Gastroenterology, Healthcare , San Antonio, Texas
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