RN Case Manager High Risk Telecommute Texas
Company: UnitedHealth Group
Location: El Paso
Posted on: June 22, 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 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.You'll enjoy the
flexibility to telecommute* from anywhere within the U.S. 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 assignedYou'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 transportationPreferred Qualifications:
- Experience working with psychiatric and geriatric patient
populations
- Bilingual (English/Spanish) language proficiency
- Bilingual (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
- Must be able to prioritize, plan, and handle multiple
tasks/demands simultaneouslyTo 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)Colorado, Connecticut or Nevada Residents Only: The salary
range for Colorado residents is $54,400 to $97,000. The salary
range for Connecticut / Nevada residents is $60,000 to $106,700.
Pay is based on several factors including but not limited to
education, work experience, certifications, etc. 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.*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, El Paso , RN Case Manager High Risk Telecommute Texas, Executive , El Paso, Texas
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