RN Case Manager High Risk Telecommute Houston TX
Company: UnitedHealth Group
Location: Houston
Posted on: June 25, 2022
Job Description:
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 -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 within the Texas 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 -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 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 planningPreferred Qualifications:
- 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
- Bilingual (English/Spanish) OR (English/Vietnamese) - -language
proficiency
- Ability to problem solve -and identify -community
-resources
- Planning, organizing, -conflict resolution, negotiating -and
interpersonal skills
- Independently utilizes -critical thinking skills, nursing
judgement -and decision-making skills
- Able to 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, Houston , RN Case Manager High Risk Telecommute Houston TX, Executive , Houston, Texas
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