Registered Nurse RN Outpatient Case Manager Healthcare Wellmed San Antonio TX

Unitedhealth Group Inc. San Antonio , TX 78245

Posted 2 months ago

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.

Job Responsibilities:

  • 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.

Required Qualifications:

  • 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

Preferred Qualifications:

  • Experience working with psychiatric and geriatric patient populations

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

law.

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


icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Registered Nurse RN Healthcare Manager Alamo Heights Wellmed San Antonio TX

Unitedhealth Group Inc.

Posted 7 days ago

VIEW JOBS 12/7/2019 12:00:00 AM 2020-03-06T00:00 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 stat that understands 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. The Healthcare Manager is responsible for successfully supporting patients with high risk health conditions to navigate the healthcare system. The Healthcare Manager assists in developing patient empowerment by acting as an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. The Healthcare Manager interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, laboratory technologists, social workers, and other educators. The Healthcare Manager acts as a resource for clinic staff. The Healthcare Manager works in a less structured, self-directed environment and performs all nursing duties within the scope of a RN license of the applicable state board of nursing. Primary Responsibilities: * Works with the providers and clinic staff to identify patients at high risk. * Supports longitudinal care of the patient with chronic care conditions by: a. performing assessment of health conditions, performing medication reconciliation, conducting Motivational Interviewing and Self-Management Goal setting, providing patient education, creating referrals to appropriate agencies and resources * Supports transition of the patient with chronic care conditions from inpatient to outpatient setting, by: a. performing assessment of transitional needs, performing medication reconciliation, establishing and reviewing contingency plan, providing patient education, assisting with post discharge needs such as prescriptions, transportation, Durable Medical Equipment (DME), appointments * Coordinate with providers to establish or update plan of care * Performs accurate and timely documentation in the electronic medical record * Participates in daily huddles and Patient Care Coordination (PCC) meetings * Prepares accurate and timely reports, as required, for weekly meetings * Maintains continued competence in nursing practice and knowledge of current evidence based practices * May perform clinical tasks within their scope of practice * Performs all other related duties as assigned WellMed at Alamo Heights is located near Broadway, 78209 behind Lincoln Shopping CTR. 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's degree in Nursing or Associate's degree in Nursing with four or more years of experience * Registered Nurse with an active and unrestricted license to practice in the state of employment * Current BLS certification * 2 years of experience in a physician's office, clinical or hospital setting * Knowledge of chronic diseases, especially COPD / asthma, diabetes, CHF and IHD * Excellent verbal and written skills * Strong interpersonal skills * Ability to interact productively with individuals and with multidisciplinary teams * Proficient computer skills to work efficiently with electronic medical records * Excellent organizational and prioritization skills * 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 Preferred Qualifications: * Experience related to patient education and / or motivational interviewing skills and self-management goal setting 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 380,000 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) 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. Job Keywords: WellMed, Healthcare, Bilingual, Registered Nurse, RN, Cardiology, Health Coach, Education, CHF, IHD, COPD / Asthma and Diabetes Disease Management, Alamo Heights, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, 78209, Texas, TX Unitedhealth Group Inc. San Antonio TX

Registered Nurse RN Outpatient Case Manager Healthcare Wellmed San Antonio TX

Unitedhealth Group Inc.