- Independently collaborates effectively with Interdisciplinary care team (ICT) to establish an individualized transition plan for members
- Independently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria within our documentation system
- Performs expedited, standard, concurrent, and retrospective onsite or telephonic clinical reviews at in network and/or out of network facilities. The Case Manager documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines for all authorizations
- Interacts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information
- Identifies member's level of risk by utilizing the Population Stratification tools and communicates during transition process the member's transition discharge plan with the ICT
- Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care
- 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
- Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in department huddles
- 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
- Takes on-call assignment as directed
- The Case Manager will also 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
- Refers cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for complex case situations
- Monitors for any quality concerns regarding member care and reports as per policy and procedure
- Performs all other related duties as assigned
- Bachelor's degree in Nursing and/or, Associate's degree in Nursing combined with 4+ years of experience above the required years of experience
- Current, unrestricted RN license specific to the state of employment
- 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
- Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
- Proven ability to read, analyze and interpret information in medical records, and health plan documents
- Proven ability to problem solve and identify community resources
- Proven planning, organizing, conflict resolution, negotiating and interpersonal skills
- Proven ability to utilize critical thinking skills, nursing judgement, and decision-making skills
- Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously
- Proven ability to frequently stand, walk or sit for prolonged periods
- Reliable transportation and ability to maintain an active driver's license
- Ability to travel within the RGV 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
-
Case Manager
2 weeks ago
Southwest Key Programs Brownsville, United StatesJob Summary:: · The Case Manager is responsible for the submission of service plans and other assessments required for the compiling of a comprehensive case file found on Southwest Key Programs (SWK) designated web-based program with supporting documentation maintained in physic ...
-
Case Manager
2 weeks ago
Texas Department of Aging & Disability Services Brownsville, United StatesJob Description: · The Case Manager position provides advanced and comprehensive case management consultation for families with children who have health risks, conditions or special health care needs. Will oversee case management services which include; traveling to conduct home ...
-
Case Manager
1 week ago
Southwest Key Programs Brownsville, United StatesJob Summary: · The Case Manager is responsible for the submission of service plans and other assessments required for the compiling of a comprehensive case file found on Southwest Key Programs (SWK) designated web-based program with supporting documentation maintained in physic ...
-
RN Case Manager
1 week ago
Good Shepherd Hospice Cameron, United StatesJob Description · Job DescriptionDescriptionGood Shepherd Hospice is seeking a compassionate candidate for a Registered Nurse Case Manager serving patients and their families in Cameron and surrounding communities. The RN provides nursing assessment, planning and care to maximize ...
-
Bilingual Case Manager
2 weeks ago
Wider Circle Brownsville, United StatesWider Circle is a Silicon Valley healthcare start-up that engages with members of the community to learn how to maintain and improve their health, and outlook on life. · We are now seeking a Case Manager who is passionate about serving and making connections with empathy and comp ...
-
Bilingual Case Manager
3 weeks ago
Wider Circle Brownsville, United StatesJob Description · Job DescriptionWider Circle is a Silicon Valley healthcare start-up that engages with members of the community to learn how to maintain and improve their health, and outlook on life. · We are now seeking a Case Manager who is passionate about serving and making ...
-
Case Manager II RN
1 week ago
MRI Brownsville, United StatesJob Description · Job Description**Remote Brownsville/Hidalgo Area** · ***MUST LIVE IN Brownsville/Hidalgo AREA*** · Walk me through the day-to-day responsibilities of this the role and a description of the project (Outside of Workday JD): · Completing assessments · Completing bi ...
-
Field-based Registered Nurse Case Manager
5 days ago
A-Line Staffing Solutions Brownsville, United StatesA-Line staffing is hiring RN Care Managers in the Brownsville, TX area · If interested APPLY NOW for IMMEDIATE consideration · RN Care Manager Details: · Location: Remote work with home visits in the Brownsville, TX area · Schedule: Monday-Friday 8:00am-5:00pm · RN Care Mana ...
-
LPN Pediatric Private Duty
3 days ago
Elk Valley Health Services, LLC Brownsville, United States Full timeWe are hiring for a Pediatric Private Duty LPN in the Brownsville, TN area to work in the patient's home. · Case Specific Enhanced Pay Rates are available with 6-12 shifts. We offer flexible scheduling, weekly pay and a loyalty bonus after your first 300 worked hours . · Elk Vall ...
-
Case Manager
2 weeks ago
Compass Connections Los Fresnos, United StatesIt's a great feeling to work for a company that does so much good for others around the world · Academic Req: Required Bachelors degree in the behavioral sciences, human services, or social services field; Preferred Graduate degree from accredited program/university in a related ...
-
Case Manager
1 week ago
Texas Health & Human Services Commission Harlingen, United StatesThe Case Manager (Social Worker II) performs complex social services work under the Program Supervisor IV. This position works under minimum supervision with considerable latitude for the use of initiative and independent judgment. · The Case Manager position provides comprehensi ...
-
Case Manager
2 weeks ago
Compass Connections Harlingen, United StatesIt's a great feeling to work for a company that does so much good for others around the world · Academic Req: Required – Bachelor's degree in the behavioral sciences, human services, or social services field; Preferred – Graduate degree from accredited program/university in a rel ...
-
Interim Healthcare - Brownsville, TX Brownsville, United StatesJob Description · Job DescriptionProvide care for the residents of Brownsville and surrounding area · At Interim Healthcare our focus is patient centered care with a philosophy of Home Life Enrichment · Job ResponsibilitiesPerforming Start of Care Visits, Recertifications, and Re ...
-
Case Manager
3 days ago
Compass Connections Los Fresnos, United StatesIt's a great feeling to work for a company that does so much good for others around the world · Academic Req: Required - Bachelor's degree in the behavioral sciences, human services, or social services field; Preferred - Graduate degree from accredited program/university in a rel ...
-
Case Manager
2 weeks ago
Southwest Key Programs San Benito, United StatesJob Summary:: · The Case Manager is responsible for completing intakes, assessments, and creation of service plans and the overall coordination and delivery of services. The Case Manager will be responsible for the documentation of services provided in our electronic client file ...
-
Case Manager
3 weeks ago
Southwest Key Programs San Benito, United StatesJob Summary: · The Case Manager is responsible for completing intakes, assessments, and creation of service plans and the overall coordination and delivery of services. The Case Manager will be responsible for the documentation of services provided in our electronic client file s ...
-
Case Manager
2 weeks ago
Texas Department of Aging & Disability Services Harlingen, United StatesJob Description: · The Case Manager (Social Worker II) performs complex social services work under the Program Supervisor IV. This position works under minimum supervision with considerable latitude for the use of initiative and independent judgment. · The Case Manager position p ...
-
RN Case Manager
3 weeks ago
Tri-County Health Care Harlingen, United StatesPosition Summary · The Case Manager will intake, coordinate, and oversee individualized care plans for pediatric patients, collaborating with healthcare professionals to ensure comprehensive treatment and support for optimal well-being. · Essential Duties and Responsibilities · T ...
-
RN Case Manager
1 week ago
Tri-County Healthcare Harlingen, United StatesJob Description · Job DescriptionPosition Summary · The Case Manager will intake, coordinate, and oversee individualized care plans for pediatric patients, collaborating with healthcare professionals to ensure comprehensive treatment and support for optimal well-being. · Essentia ...
-
Lead Caregiver
3 days ago
Titan Industries Villa Pancho, TX, United States Freelance**Lead Caregiver (m/f/d) for Geriatrics**: Full-time | Nuremberg · At our facility, you will not only experience top-quality medical care, but also have excellent career opportunities. Join our team and actively shape the future of healthcare. We offer more than just a job, but a ...
In-Patient Case Manager RN - Brownsville, TX, United States - Optum
Description
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 Case Manager II - Inpatient Services performs onsite review or telephonic clinical review of inpatient admissions in an acute hospital, rehabilitation facility, LTAC or skilled nursing facility. Actively implements a plan of care utilizing approved clinical guidelines to transition and 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 case manager is responsible for coordinating the care from admission through discharge. The Case Manager participates in Patient Care Conferences to review clinical status, update/finalize transition discharge needs, and identify members at risk for readmission.
Primary Responsibilities:
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:
Preferred Qualifications:
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.
