Registered Nurse RN Inpatient Case Manager Healthcare WellMed El Paso TX
Company: UnitedHealth Group
Location: South Houston
Posted on: August 7, 2022
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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 Case Manager II - Inpatient Services performs onsite review or
telephonic clinical review of inpatient admissions in an acute
hospital, rehabilitation facility, LTAC or skilled nursing
facility. Actively implements a plan of care utilizing approved
clinical guidelines to transition and 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
case manager is responsible for coordinating the care from
admission through discharge. The Case Manager participates in
Patient Care Conferences to review clinical status, update/finalize
transition discharge needs, and identify members at risk for
readmission.
Primary Responsibilities:
Independently collaborates effectively with Interdisciplinary care
team (ICT) to establish an individualized transition plan for
members
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
Performs expedited, standard, concurrent, and retrospective onsite
or telephonic clinical reviews at in network and/or out of network
facilities. The Case Manager documents medical necessity and
appropriate level of care utilizing national recognized clinical
guidelines for all authorizations
Interacts and effectively communicates with facility staff, members
and their families and/or designated representative to assess
discharge needs, formulate discharge plan and provide health plan
benefit information
Identifies member's level of risk by utilizing the Population
Stratification tools and communicates during transition process the
member's transition discharge plan with the ICT
Conducts a transition discharge assessment onsite and/or
telephonically to identify member needs at time of transition to a
lower level of care
Manages assigned case load in an efficient and effective manner
utilizing time management skills
Demonstrates exemplary knowledge of utilization management and care
coordination processes as a foundation for transition planning
activities
Independently confers with UM Medical Directors and/ or Market
Medical Directors on a regular basis regarding inpatient cases and
participates in department huddles
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
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 and maintain hospital credentialing as
indicated
Decision-making is based on regulatory requirements, policy and
procedures and current clinical guidelines
Maintains current knowledge of health plan benefits and provider
network including inclusions and exclusions in contract terms
Refers cases to UM Medical Director as appropriate for review for
cases not meeting medical necessity criteria or for complex case
situations
Monitors for any quality concerns regarding member care and reports
as per policy and procedure
Performs all other related duties as assigned
This is an -office-based near Miriam Dr. and Gateway I - 10
(Eastside) . This position will require weekly onsite visits to
IP-next site of care facilities-Long Term Acute Care, Inpatient
Rehab and Skill Nursing Facility sites. Mileage reimbursement. Paid
on - calls.
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 4+ years of experience above the required years of
experience
Current, unrestricted RN license required, specific to the state of
employment
Case Management Certification (CCM) or ability to obtain CCM within
12 months after the first year of employment
4+ years of diverse clinical experience 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
Knowledgeable in Microsoft Office applications including Outlook,
Word, and Excel
Ability to read, analyze and interpret information in medical
records, and health plan documents
Frequently required to stand, walk or sit for prolonged periods
Reliable transportation and Case Manager is responsible for
maintaining an active driver's license
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
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
Preferred Qualifcations:
Experience working with psychiatric and geriatric patient
populations
Bilingual (English/Spanish) language proficiency
Ability to problem solve and identify community resources
Planning, organizing, conflict resolution, negotiating and
interpersonal skills
Utilize critical thinking skills, nursing judgement, and decision
making skills
Must be able to prioritize, plan, and handle multiple tasks/demands
simultaneously
Physical & Mental Requirements:
Ability to lift up to 25 pounds
Ability to push or pull heavy objects using up to 10 pounds of
force
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or
machinery
Ability to receive and comprehend instructions verbally and/or in
writing
Ability to use logical reasoning for simple and complex problem
solving
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.
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.
OptumCare is a drug-free workplace. Candidates are required to pass
a drug test before beginning employment.
Keywords: UnitedHealth Group, Houston , Registered Nurse RN Inpatient Case Manager Healthcare WellMed El Paso TX, Executive , South Houston, Texas
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