- The Outpatient Case Manager 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 a 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
- 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+ years of experience
- Current unrestricted Texas RN license or compact license
- Case Management Certification (CCM) or ability to obtain CCM within 1 year of employment
- 5+ years of diverse clinical experience with experience in caring for the acutely ill patients with multiple disease conditions
- 3+ years of case management experience
- Knowledge of utilization management, quality improvement, discharge planning, and cost management
- Proficient with Microsoft Office applications including Word, Excel, and Power Point
- 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
- Certified Diabetes Educator, or Certified Case Manager
- Experience working with psychiatric and geriatric patient populations
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Registered Nurse RN Outpatient Case Manager McAllen Texas - Pharr, 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 primary responsibility of the Outpatient 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 OP CM 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 OP CM will participate in integrated care team conferences to review clinical assessments, update care plans and determine follow-up frequency with the team. The OP Case Manager performs telephonic and face to face assessments.
Primary Responsibilities:
Required Qualifications:
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.
