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