Optum WellMed has an opportunity for a Registered Nurse!
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)
Location: 3434 Saratoga, Corpus Christi, TX
Hours: Mon-Fri 8-5
The Case Manager II - Outpatient Services RN actively implements a plan of care utilizing approved clinical guidelines to 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 outpatient case manager is responsible for successfully supporting patients with high risk health conditions at time of discharge and/or transition of care. The Case Manager collaborates with multi-disciplinary care teams to include physicians, nurses, social workers and other educators.
- Independently collaborates effectively with Interdisciplinary care team (ICT) to establish an individualized transition plan for members
- Make outbound calls and receive inbound calls to assess members' current health status
- Identify gaps or barriers in treatment plans
- Provide patient education to assist with self-management
- Make referrals to outside sources
- Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
- Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheel
- 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
- Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better on a monthly basis
- Adheres to organizational and departmental policies and procedures
- 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
- Monitors for any quality concerns regarding member care and reports as per policy and procedure
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.
- Bachelor’s degree in Nursing and/or Associate’s degree in Nursing combined with 4+ years of experience
- Current, unrestricted RN license required in the state of TX
- 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
- Proficiency in Microsoft Office applications including Outlook, Word and Excel
- Reliable transportation that will enable you to travel to client and/or patient sites within a designated area
- Experience working with psychiatric and geriatric patient populations
- Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
- Bilingual (English / Spanish) language proficiency
- Ability to read, analyze and interpret information in medical records and health plan documents
- Ability to problem solve and identify community resources
- Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
- Must be able to prioritize, plan and handle multiple tasks / demands simultaneously
- Utilize critical thinking skills, nursing judgement and decision making skills
- Frequently required to stand, walk or sit for prolonged periods
- 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
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 350,000+ 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)
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.
Job Keywords: Registered Nurse, RN, Nurse, Outpatient, Out Patient, Managed Care, Case Manager, Case Management, WellMed, Optum, UHG, UnitedHealth, Geriatric, Nursing, Clinical, Corpus Christi, TX, Texas