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)
WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.
Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)
The primary responsibility of the Case Manager is to identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a case management care plan. They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers, educators, health care coordinators/managers. The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence. The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions. The Case Manager may perform telephonic and/or face-to-face assessments.
In consultation with manager of Care Management, conducts initial assessments within designated time frames for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
In consultation with manager of Care Management collaborates effectively with IDT to establish an individualized care plan for members with interventions to assist the member in meeting short and long term goals
Engage patient, family, and caregivers to assure that a well-coordinated care plan is established.
Will identify member needs, develop care plan and prioritize goals; using evidence based practice the Case Manager will develop interventions while considering member barriers with guidance from medical directors and Manager of Care Management
Make outbound calls to assess member health status, identify gaps or barriers in care plan
Provide member education to assist with self-management goals
Make referrals to outside sources
Educate members on disease process or acute condition and provide indicated contingency plan with guidance from medical directors and Manager of Care Management
Coordinates visits with PCP and specialists on a limited basis, performs visual assessment for skin checks on exposed skin, and conducts home safety evaluation
Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a monthly basis
Adheres to organizational and departmental policies and procedures
Takes on-call assignment as directed
The Case Manager will also maintain current licensure to work in state of employment. Decision making is based on regulatory requirements, policies and procedures, and current clinical guidelines
Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
Monitors for quality concerns regarding member care and reports as per policy and procedure.
Performs all other related duties as assigned
Full-Time Field Base Position: This position requires 100% traveling around the San Antonio, TX and counties areas supporting WellMed Patients. Must have reliable transportation and available to work flexible shifts. Rotating on-calls required
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.
Education required: Bachelor's degree in Nursing, and/or Associate's degree in Nursing combined with two or more years of experience and/or Nursing Diploma
Current unrestricted Registered Nurse license, specific to the state of employment
Three or more years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
Two or more years of managed care and/or case management experience
Knowledge of utilization management, quality improvement and discharge planning
Must have reliable transportation that will enable you to travel to client and/or patient sites within a designated area
Ability to read, analyze, 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
Proficient with Microsoft Office applications including Outlook, Word, and Excel
Utilize critical thinking skills, nursing judgement and decision making skills. Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
Frequently require to stand, walk or sit for long periods
Case Management certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
Transforming health care and millions of lives starts with the values you embrace and the passion you bring. Find out more and join us. It's an everyday opportunity to do to achieve 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.
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment
Job Keywords: WellMed, Healthcare, Bilingual, Registered Nurse, RN, Inpatient Case Manager, CM, Complex Care, Utilization Management, Hospital, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, 78249, Texas, TX
Unitedhealth Group Inc.