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RN Case Manager PHM Telecommute Corpus Christi

Company: UnitedHealth Group
Location: Robstown
Posted on: September 20, 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 lifes best work.(sm)

TheNurse CaseManagerII (NCM)is responsible for patientcase management for longitudinalengagement,coordination for discharge planning, transition ofcareneedsand outpatient patient management through thecarecontinuum. Nurse Case Managerwill identify, screen, track, monitorandcoordinate thecare of patients with multipleco-morbiditiesand/orpsychosocial needsand develop a patientsaction planand/or discharge plan. They will perform reviews ofcurrent inpatient services and determine medicalappropriateness of inpatientand outpatient services followingevaluation of medicalguidelinesandbenefit determination. The Nurse Case Manager will providecontinuityofcare for members toanappropriate lower levelofcare incollaboration with the hospitals/physician team,acute or skilled facility staff,ambulatorycareteam,and the memberand/orfamily/caregiver. The Nurse Case Manager willcoordinate, or provideappropriate levels ofcare under the direct supervision ofan RN Manager or MD.Function is responsible forclinical operationsand medical managementactivitiesacross thecontinuum ofcare (assessing, planning, implementing,coordinating, monitoringandevaluating). This includescase management,coordination ofcare,and medical managementconsulting.Function mayalso be responsible for providing healtheducation,coachingand treatmentdecision support for patients. The Nurse Case Manager willactasanadvocate for patientsand theirfamiliesguide them through the healthcaresystem for transitionplanningandlongitudinalcare. The Nurse Case Manager will work in partnership with anassigned Care AdvocateandSocialWorker.

If you are located within the Corpus Christi, Texas area, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:

  • Engage patient,family,andcaregivers telephonically to assure that a well-coordinatedaction plan isestablishedandcontinuallyassesshealth status
  • Provide membereducation to assist with self-managementgoals; diseasemanagement oracutecondition and provide indicatedcontingency plan
  • Identify patient needs,close healthcare gaps, develop action planand prioritizegoals
  • Utilizingevidenced-based practice,developinterventions whileconsidering member barriers independently
  • Provide patients with"welcome home"calls to ensure that discharged patientsreceive the necessary servicesand resourcesaccording totransition plan
  • Conducts a transition dischargeassessment onsiteand/or telephonically to identify member needsattime of transitionto a lower level ofcare
  • Independently servesastheclinicalliaison with hospital, clinical andadministrative staffaswellas performs a review forclinical authorizations for inpatientcare utilizingevidenced-basedcriteria within our documentationsystem for discharge planningand/or next site ofcare needs
  • Inpartnership withcareteamtriad,make referralstocommunity sourcesand programs identified for patients
  • Utilize motivational interviewing techniques to understandcauseandeffect,gather or review health history forclinicalsymptoms,anddetermine health literacy
  • Managesassessments regardingpatienttreatment plansandestablishcollaborative relationships with physicianadvisors,clients, patients, and providers
  • Collaborateseffectively withInterdisciplinary Care Team(IDCT) to establishan individualized transition planand/oraction planfor patients
  • Independentlyconfers with UM Medical Directorsand/ or Market Medical Directors on a regularbasis regarding inpatient casesand participates in departmental huddles
  • Demonstrate knowledge of utilization management processesandcurrent standards ofcareas a foundation for utilization reviewandtransition planningactivities
  • Maintainin-depth knowledge ofallcompany products and servicesaswellascustomer issuesand needs through ongoing trainingandself-directed research
  • Manageassignedcaseload in anefficient andeffective manner utilizing time management skills
  • Enters timelyandaccurate documentation into designatedcare managementapplications to comply with documentation requirementsandachieveaudit scores of 95% or better on a monthly basis
  • Maintain currentlicensure to work in state ofemploymentandmaintain hospitalcredentialingas indicated
  • Performsall otherrelated dutiesasassigned

    Youll 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:

    • Associates degree in Nursing
    • Current, unrestricted RN license, specific tothe state ofemployment or a compact nursing license
    • Case ManagementCertification (CCM) orability to obtainCCM within 12 monthsafter thefirstyearofemployment
    • 3+years of diverseclinical experience; preferred incaring for theacutely ill patients withmultiple diseaseconditions
    • 3+years ofmanagedcareand/orcase managementexperience
    • Demonstrated knowledge of utilization management, quality improvement,and discharge planning

      Preferred Qualifications:

      • Experience working with psychiatricand geriatric patient populations
      • Ability to problem solveand identifycommunityresources
      • Experience in planning, organizing,conflict resolution, negotiatingand interpersonal skills
      • Ability to independently utilizecritical thinking skills, nursing judgementand decision-making skills
      • Ability to prioritize, plan,and handle multiple tasks/demands simultaneously
      • Demonstrated knowledge in Microsoft Officeapplications including Outlook,Word,and Excel Ability toread,analyzeand interpretinformationin medical records,andhealth plan documents
      • Bilingual (English/Spanish) OR (English/Vietnamese)language proficiency
      • 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

        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 doyour 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 Groups 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.Required
        Job Industries
        • Transportation

Keywords: UnitedHealth Group, Corpus Christi , RN Case Manager PHM Telecommute Corpus Christi, Executive , Robstown, Texas

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