UnitedHealth Group

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RN--Audit Case Manager - Wellmed - El Paso, Corpus Christi or Rio Grande Valley, TX - 713558

at UnitedHealth Group

Posted: 9/5/2017
Job Status: Full Time
Job Reference #: 713558
Keywords: respiratory

Job Description

Position Description

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

 

The primary responsibility of the Case Manager is to identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a case management plan of care. They will interact and collaborate with interdisciplinary care team, which includes physicians, transition care managers (i.e., UM inpatient case managers), referral coordinators, pharmacists, social workers, and other educators and nurses.  The Case Manager  also acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence. The Case Manager will participate in integrated care team conferences to review clinical assessments, update care plans and determine follow-up frequency with the team. The Case Manager performs telephonic and face to face assessments. 

 

 

 

Please note: This position will be both office based and will require travel as needed. The RN in this role can be based in El Paso, Corpus Christi or the Rio Grande Valley. The RN will be responsible for peer to peer training and auditing as needed or directed by the manager.

 

Primary Responsibilities:

  • Conducts initial assessments within designated timeframes on patients identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
  • Collaborates effectively with integrated care team to establish an individualized plan of care for members.  The integrated care team includes physicians, case managers, referral coordinators, pharmacists, social workers, and other disease educators.  Develops interventions to assist the member in meeting short and long term plan of care goals

  • Engage patient, family, and caregivers to assure that a well-coordinated treatment plan is established

  • Prioritize care needs, set goals and develop an initial plan of care that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation

  • Make outbound calls to assess member health status, identify gaps or barriers in treatment plans

  • Provide member education to assist with self- management goals

  • Make referrals to outside sources
  • Educate members on disease process or acute condition

  • Coordinates and attends member visits with PCP and specialists as needed in special circumstances

  • On limited bases, a physical assessment may include taking of blood pressure, heart rate, respiratory assessment: Rate, effort, pulse oximetry, peripheral circulation and skin checks on exposed skin, foot checks for edema and skin integrity, home safety evaluation

  • Seeks ways to improve job efficiency and makes appropriate suggestions following the appropriate chain of command

  • Performs all duties for internal and external customers in a professional and responsible      manner having fewer than two complaints per year

  • Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a quarterly basis

  • Adheres to organizational and departmental policies and procedures

  • Takes on-call assignment as directed

  • Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms

  • With the assistance of the Managed Care/UM teams, guides physicians in their awareness of preferred contracts and providers and facilities

  • Attends educational offering to keep abreast of change and comply with licensing requirements and assists in the growth and development of associates by sharing knowledge with others

  • Participates in the development of appropriate QI processes, establishing and monitoring indicators

  • Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations

  • Performs all other related duties as assigned

 

 

 



Requirements

To be considered for this position, applicants need to meet the qualifications listed in this posting.

Required Qualifications:

  • Education:

    • Bachelor’s degree in Nursing, or

    • Associate’s degree in Nursing and Bachelor’s degree in related field, or

    • Associate’s degree in Nursing combined with 4 or more years of experience

  • Registered Nurse with current licensure to practice in the applicable state

  • Case Management Certification (CCM) or ability to obtain CCM within 1 year of employment

  • Diverse clinical experience with 5 or more years of experience in caring for the acutely ill patients with multiple disease conditions

  • 3 or more years case management experience

  • Knowledge of utilization management, quality improvement, discharge planning, and cost management

  • Strong organizational skills and multitasking abilities

  • Ability to solve complex problems; critical thinking skills

  • Strong verbal communication skills

  • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills

  • Proficient with Microsoft Office applications including Word, Excel, and Power Point

  • Independent problem identification/resolution and decision making skills

  • Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously

Preferred Qualifications:

  • Certified Diabetes Educator or Certified Case Manager

  • Experience working with psychiatric and geriatric patient populations

 

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 90,000+ 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: RN, registered nurse, case manager, case management, chart review, chart audit, NCQA, disease manager, disease management, geriatric, Medicare Advantage, telephonic, WellMed, UnitedHealth Group, UHG, UnitedHealthcare, UHC, El Paso, Corpus Christi, Rio Grande Valley, TX, Texas

Application Instructions

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