RN Case Manager PHM Telecommute San Antonio Texas

Nurse Case Manager IIDo 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.The Nurse Case Manager II 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 within SA area, you will have the flexibility to work remotely as you take on some tough challengesPrimary Responsibilities:Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health statusProvide member education to assist with self-management goals; disease management or acute condition and provide indicated contingency planIdentify patient needs, close health care gaps, develop action plan and prioritize goalsUtilizing evidenced-based practice, develop interventions while considering member barriers independentlyProvide patients with "welcome home" calls to ensure that discharged patients' receive the necessary services and resources according to transition planConducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of careIndependently 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 needsIn partnership with care team triad, make referrals to community sources and programs identified for patientsUtilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacyManages assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providersCollaborates effectively with Interdisciplinary Care Team (IDCT) to establish an individualized transition plan and/or action plan for patientsIndependently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in departmental huddlesDemonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning activitiesMaintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed researchManage assigned caseload in an efficient and effective manner utilizing time management skillsEnters 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 basisMaintain current licensure to work in state of employment and maintain hospital credentialing as indicatedPerforms all other related duties as assignedYou'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 NursingCurrent, unrestricted RN license, specific to the state of employment or a compact nursing licenseCase Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment3+ years of diverse clinical experience; preferred in caring for the acutely ill patients with multiple disease conditions3+ years of managed care and/or case management experienceKnowledge of utilization management, quality improvement, and discharge planningAccess to reliable transportationPreferred Qualifications:Experience working with psychiatric and geriatric patient populationsKnowledgeable in Microsoft Office applications including Outlook, Word, and Excel Ability to read, analyze and interpret information in medical records, and health plan documentsBilingual (English/Spanish) language proficiencyBilingual (English/Vietnamese) language proficiencyDemonstrates planning, organizing, conflict resolution, negotiating and interpersonal skillsProven independently utilizes critical thinking skills, nursing judgement and decision-making skillsProven ability to problem solve and identify community resourcesProven ability to prioritize, plan, and handle multiple tasks/demands simultaneouslyCareers 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.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 employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyAt 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.