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 Nurse Case Manager is a participant in the collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs. This process includes medical, social, developmental, behavioral, financial, and educational intervention with focus on quality and cost effective outcomes.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Engage and provide care management to commercial patient populations identified from the Health Plan, clinical meetings, outlier reports, plan specific insights, and predictive modeling
- Complete Transition of Care follow up and assessment post discharge
- Provide care management telephonically
- Complete required assessments
- Create a personalized care plan for each patient involved in care management to resolve barriers to care, close quality gaps in care, build additional education or contingency planning and engage with social support systems as appropriate
- Regularly interact with health plan clinical programs and clinical personnel for care coordination
- Complete all necessary care coordination and or assessment activities as outlined in the care plan
- At least monthly or as needed, attend telephonic patient care conferences/meetings with the clinic or health plan on assigned patients involved in care management
- Weekly and as needed, participate in internal JOC meetings for plan specific insights, best practices and intervention development
- Follow NCQA Care Management, Person Centered Medical Home and Accountable Care Organization accreditation standards
- Document all patient care activities into electronic database
- Meet required Key Performance Indicators
- Pass Quality Audit metrics
- Coordinate and cooperate with other members of the care management team
- Support team through onboarding and training of new hire members
- Perform other 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.
- 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
- Eletronic case manageemtn and medical record experience
- Knowledge of utilization management, quality improvement, and discharge planning
- 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
- Ability to problem solve and identify community resources
- Knowledge of healthcare reimbursement, Utilization Management, discharge planning, Disease Management
- Intermediate knowledge of Commercial Plans, applicable state Department of Insurance regulations and health plans
- Knowledge of NCQA standards in Primary Care Medical Home and Care Management, as well as Accountable Care Organization
- Possess 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
"UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status."
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)
Colorado Residents Only: The salary range for Colorado residents is $53,300 to $95,100. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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, PHM, Healthcare, Bilingual, Registered Nurse, Case Manager, Population Health Management, Telephonic Special Needs Population, CMS, NCQA, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Texas