RN Clinic Case Manager Elgin - Case Management
Company: UnitedHealth Group Inc
Location: Elgin
Posted on: January 26, 2023
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Job Description:
RN Clinic Case Manager ElginDo 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 I (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. The Nurse Care Manager will
determine medical appropriateness of outpatient services following
evaluation of medical guidelines and benefit determination. The
Nurse Case Manager will coordinate, or provide appropriate levels
of care under the direct supervision of an RN 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. This role acts as a support to team members,
coaching, guiding and providing feedback as necessary. 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.
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
* With oversight of RN and/or MD, utilizing evidence-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
* 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 assigned
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:
* Licensed Practical/Vocational Nurse
* Current, unrestricted LPN/LVN license in the state of Texas
* 2+ years of managed care and/or case management experience
* 2+ years of clinical experience
* Knowledge of managed care, medical terminology, referral process,
claims and ICD-10 codes
* 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 Qualifications:
* Case Management certification
* Knowledge of utilization management and/or insurance review
processes as well as current standards of care, a strong knowledge
of health care delivery systems and the ability to interact with
medical directors, physician advisors, clinicians and support
staff
* Proficient computer skills in Microsoft applications and
Microsoft Excel
* Ability to work independently in accomplishing assignments,
program goals and objectives
* Excellent verbal and written skill
* Skills in planning, organizing, conflict resolution, negotiation
and interpersonal skills to work with autonomy in meeting case
management goals and initiatives
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.
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 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 Inc, Austin , RN Clinic Case Manager Elgin - Case Management, Executive , Elgin, Texas
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