RN Case Manager PHM Telecommute DFW Texas - Case Management
Company: UnitedHealth Group Inc
Location: Fort Worth
Posted on: November 19, 2023
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Job Description:
RN Case Manager PHM Telecommute DFW TexasDo 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 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 within the TX area you will have the
flexibility to telecommute* 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
Preferred Qualifications:
* Experience working with psychiatric and geriatric patient
populations
* Bilingual (English/Spanish) OR (English/Vietnamese) language
proficiency
* 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
* Possess planning, organizing, conflict resolution, negotiating
and interpersonal skills
* Independently utilizes critical thinking skills, nursing
judgement and decision-making skills
* Prioritize, plan, and handle multiple tasks/demands
simultaneously
* Full COVID-19 vaccination is an essential job function of this
role. Candidates located in states that mandate COVID-19 booster
doses must also comply with those state requirements. UnitedHealth
Group will adhere to all federal, state and local regulations as
well as all client requirements and will obtain necessary proof of
vaccination, and boosters when applicable, prior to employment to
ensure compliance. Candidates must be able to perform all essential
job functions with or without reasonable accommodation
To protect the health and safety of our workforce, patients and
communities we serve, UnitedHealth Group and its affiliate
companies require all employees to disclose COVID-19 vaccination
status prior to beginning employment. In addition, some roles and
locations require full COVID-19 vaccination, including boosters, as
an essential job function. UnitedHealth Group adheres to all
federal, state and local COVID-19 vaccination regulations as well
as all client COVID-19 vaccination requirements and will obtain the
necessary information from candidates prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation. Failure to meet
the vaccination requirement may result in rescission of an
employment offer or termination of employment
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)
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.
* 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.
Keywords: UnitedHealth Group Inc, Fort Worth , RN Case Manager PHM Telecommute DFW Texas - Case Management, Executive , Fort Worth, Texas
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