Registered Nurse RN Case Manager ICM West Texas - Case Management
Company: UnitedHealth Group Inc
Location: San Angelo
Posted on: April 16, 2024
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Job Description:
Registered Nurse RN Case Manager ICM West Texas
Opportunities at WellMed, part of the Optum family of businesses.
We believe all patients are entitled to the highest level of
medical care. Here, you will join a team who shares your passion
for helping people achieve better health. With opportunities for
physicians, clinical staff and non-patient-facing roles, you can
make a difference with us as you discover the meaning behind
Caring. Connecting. Growing together.
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 West 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
* Access to reliable transportation
Preferred Qualifications:
* Experience working with psychiatric and geriatric patient
populations
* Knowledgeable in Microsoft Office applications including Outlook,
Word, and Excel Ability to read, analyze and interpret information
in medical records, and health plan documents
* Bilingual (English/Spanish) language proficiency
* Bilingual (English/Vietnamese) language proficiency
* Ability to problem solve and identify community resources
* 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 simultaneously
* 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.
UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealth Group Inc, San Angelo , Registered Nurse RN Case Manager ICM West Texas - Case Management, Executive , San Angelo, Texas
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