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)
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.
The primary responsibility of the Care Manager RN is to identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and / or psychosocial needs and develop a nursing 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 Care Manager RN 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 Care Manager RN will participate in interdisciplinary conferences to review clinical assessments, update care plans and determine follow-up frequency with the team. The Care Manager performs non-invasive home and / or in-patient facility, assessments. Home assessments may include: medication reconciliation, education and a home safety evaluation.
This position is based out of the office and will be responsible for contacting patients telephonically and field visits are required. 2 - 4 weeks onsite training in Tampa, FL and reporting to the Tampa, FL office once a month for a group meeting.
Territory includes: North Tampa area, Wesley Chapel, and Zephyrhills areas.
- Collaborates effectively with interdisciplinary team to establish an individualized plan of care for members
- The interdisciplinary 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
- Provide assessments of physical and psycho-social needs in settings not limited to the PCP office, hospital, or member’s home
- Develops interventions and processes to assist the patient in meeting short and long term plan of care goals
- Coordinates and attends member visits with PCP and specialists as needed
- Physical Assessment Tasks 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
- 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 indicators
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.
- Bachelor’s degree in Nursing, or Associate’s degree in Nursing and Bachelor’s degree in related field, or Associate’s degree in Nursing combined with 4+ years of experience
- Registered Nurse with current licensure to practice in the applicable state
- Case Management Certification (CCM) or ability to obtain CCM within one year of employment
- Diverse clinical experience with 5+ years of experience in caring for the acutely ill patients with multiple disease conditions
- Proficient with Microsoft Office applications including Word, Excel, and Power Point
- 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
- Certified Diabetes Educator, or Certified Case Manager preferred
- Experience working with geriatric patient populations
- Experience with Managed Care and Medicare
- Experience working on Care One or True Care
- Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
- Independent problem identification / resolution and decision making skills
- Ability to prioritize, plan, and handle multiple tasks / demands simultaneously
If the hired individual resides in Florida (office based or ) this position requires the AHCA Level II background check (fingerprinting) by the State of Florida for all clinicians that have direct face to face contact with members OR employees who will have access to confidential patient data and will require renewal every five years.
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 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: RN, Case Manager, outpatient, managed care, field, high risk, provider, education, Tampa, FL