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 primary responsibility of the Case Manager is to identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a case management care plan. They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers, educators, health care coordinators/managers. The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence. The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions. The Case Manager may perform telephonic and/or face-to-face assessments.
- Independently conducts initial assessments within designated timeframes for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
- Collaborates effectively with IDT to establish an individualized care plan for members with interventions to assist the member in meeting short- and long-term goals
- Engage patient, family, and caregivers to assure that a well-coordinated care plan is established
- Identifies member needs, develop care plan and prioritize goals; using evidence-based practice the Case Manager will develop interventions while considering member barriers independently
- Make outbound calls to assess member health status, identify gaps or barriers in care plan
- Provide member education to assist with self-management goals
- Make referrals to outside sources
- Educate members on disease process or acute condition and provide indicated contingency plan
- Coordinates visits with PCP and specialists as needed on a limited basis, performs visual assessment for skin checks on exposed skin, and conducts home safety evaluation
- Independently confers with Market MD Medical Directors and/or PCPs on a regular basis regarding Complex Care/High Risk Population members and participates in department huddles
- Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a monthly basis.
- Adheres to organizational and departmental policies and procedures
- Takes on-call assignment as directed
- Maintain current licensure to work in state of employment. Decision making is based on regulatory requirements, policies 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 quality concerns regarding member care and reports as per policy and procedure. 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.
- Education required:
- Bachelor’s degree in Nursing, and/or
- Associate’s degree in Nursing combined with two or more years of experience
- Current unrestricted Registered Nurse license, Texas or compact license
- 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
- Proficient with 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
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
- Experience working with psychiatric and geriatric patient populations
- Bilingual (English/Spanish) language proficiency
- Ability to read, analyze, 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
- Independently utilizes critical thinking skills, nursing judgment and decision making skills Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously
Physical & Mental Requirements:
- Ability to lift up to 50 pounds
- Ability to push or pull heavy objects using up to 25pounds 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
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)
**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.
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: CCM, case manager, dallas, texas, tx, outpatient, disease management, case management, health plan, medicare, cms
Please see job description.