Fontana, California
Lafayette, Indiana
Indianapolis, Indiana
Lafayette, Indiana
Lafayette, Indiana
Posted: 29-Aug-24
Location: Carrollton, Texas
Salary: Open
Internal Number: 141846508
$1,500 Sign-on Bonus for External Candidates
Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
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, specific to the state of employment
- 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
- Proven excellent verbal and written skills
- 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
Preferred Qualifications:
- Case Management certification
- Knowledge of utilization management and/or insurance review processes as well as current standards of care, a solid 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
- Proven skill in planning, organizing, conflict resolution, negotiation and interpersonal skills to work with autonomy in meeting case management goals and initiatives
- Proven ability to work independently in accomplishing assignments, program goals and objectives
Physical & Mental Requirement:
- Ability to properly drive and operate a company vehicle
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.
