Case Manager, RN – WellMed – Jacksonville

UnitedHealth Group
November 3, 2020
Jacksonville, FL
Job Type


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 primary responsibility of the Case Manager is to identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a case management plan of care. They will interact and collaborate with interdisciplinary care team, which includes physicians, transition care managers (i.e., UM inpatient case managers), referral coordinators, pharmacists, social workers, and other educators and nurses. The Case Manager also acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence. The Case Manager will participate in integrated care team conferences to review clinical assessments, update care plans and determine follow-up frequency with the team. The Case Manager performs telephonic and face to face assessments.

Primary Responsibilities:

  • Conducts initial assessments within designated timeframes on patients identified as having
    complex case management needs (assessment areas include clinical, behavioral, social,
    environment and financial)
  • Collaborates effectively with integrated care team to establish an individualized plan of care
    for members. The integrated care team includes physicians, case managers, referral
    coordinators, pharmacists, social workers, and other disease educators. Develops
    interventions to assist the member in meeting short and long term plan of care goals
  • Engage patient, family, and caregivers to assure that a well coordinated treatment plan is
  • Prioritize care needs, set goals and develop an initial plan of care that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation
  • Make outbound calls to assess member health status, identify gaps or barriers in treatment plans
  • Provide member education to assist with self- management goals
  • Make referrals to outside sourcesEducate members on disease process or acute condition
  • Coordinates and attends member visits with PCP and specialists as needed in special
  • On a limited bases, a physical assessment may include taking of blood pressure, heart rate, respiratory assessment: Rate, effort, pulse oximetry, peripheral circulation and skin checks on exposed skin, foot checks for edema and skin integrity, home safety evaluation
  • Seeks ways to improve job efficiency and makes appropriate suggestions following the
    appropriate chain of command
  • The information listed above is not comprehensive of all duties/responsibilities performed
  • This job description is not an employment agreement or contract. Management has the
    exclusive right to alter this job description at any time without notice
  • Performs all duties for internal and external customers in a professional and responsible
    manner having fewer than two complaints per year
  • Enters timely and accurate data into designated care management applications and
    maintains audit scores of 90% or better on a quarterly basis
  • Adheres to organizational and departmental policies and procedures
    • Takes on-call assignment as directed
  • Maintains current knowledge of health plan benefits and provider network including
    inclusions and exclusions in contract terms
    • With the assistance of the Managed Care/UM teams, guides physicians in their
      awareness of preferred contracts and providers and facilities
  • Attends educational offering to keep abreast of change and comply with licensing
    requirements and assists in the growth and development of associates by sharing knowledge with others
  • Participates in the development of appropriate QI processes, establishing and monitoring
  • Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • 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.

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