Description
**Opportunities at WellMed** , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind **Caring. Connecting. Growing together.??**
The primary responsibility of the Case Manager is to identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a case management care plan. They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers, educators, health care coordinators/managers. The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence. The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions. The Case Manager may perform telephonic and/or face-to-face assessments.
**Primary Responsibilities:**
In consultation with manager of Care Management, conducts initial assessments within designated time frames for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
In consultation with manager of Care Management collaborates effectively with IDT to establish an individualized care plan for members with interventions to assist the member in meeting short and long term goals
Engage patient, family, and caregivers to assure that a well-coordinated care plan is established
Will identify member needs, develop care plan and prioritize goals; using evidence based practice the Case Manager will develop interventions while considering member barriers with guidance from medical directors and Manager of Care Management
Make outbound calls to assess member health status, identify gaps or barriers in care plan
Provide member education to assist with self-management goals
Make referrals to outside sources
Educate members on disease process or acute condition and provide indicated contingency plan with guidance from medical directors and Manager of Care Management
Coordinates visits with PCP and specialists on a limited basis, performs visual assessment for skin checks on exposed skin, and conducts home safety evaluation
Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a monthly basis
Adheres to organizational and departmental policies and procedures
Takes on-call assignment as directed
The Case Manager will also maintain current licensure to work in state of employment. Decision making is based on regulatory requirements, policies and procedures, and current clinical guidelines
Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
Monitors for quality concerns regarding member care and reports as per policy and procedure
Performs all other related duties as assigned
This is a full-time field based position. This position requires 50% traveling around the San Antonio, TX and counties areas supporting WellMed Patients. Candidates must have reliable transportation and available to work flexible shifts. Rotating on-calls required
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:**
Bachelor's degree in Nursing, and/or Associate's degree in Nursing combined with 2+ years of experience and/or Nursing Diploma
Current unrestricted Registered Nurse license, specific to the state of employment
Case Management certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
3+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
2+ years of managed care and/or case management experience
Proven knowledge of utilization management, quality improvement and discharge planning
Proficient with Microsoft Office applications including Outlook, Word, and Excel
Proven ability to utilize critical thinking skills, nursing judgement and decision making skills. Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously
Proven ability to read, analyze, interpret information in medical records and health plan documents
Proven ability to problem solve and identify community resources
Proven planning, organizing, conflict resolution, negotiating and interpersonal skills
Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area
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
**Preferred Qualification:**
Experience working with psychiatric and geriatric patient populations
**Physical Qualification:**
Ability to frequently to stand, walk or sit for long periods
-At 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: 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 characteristi
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