- 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
- Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care
- 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 for discharge planning and/or next site of care needs
- 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
- 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.
- Current, unrestricted RN license, specific to the state of employment or a compact nursing license
- Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
- 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 Ability to read, analyze and interpret information in medical records, and health plan documents
- Bilingual (English/Spanish) language proficiency
- Bilingual (English/Vietnamese) language proficiency
- Ability to problem solve and identify community resources
- Planning, organizing, conflict resolution, negotiating and interpersonal skills
- Independently utilizes critical thinking skills, nursing judgement and decision-making skills
- All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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West Central Texas Anesthesiology Team
3 weeks ago
Enterprisemed San Angelo, United StatesA hospital in San Angelo, TX is adding a BC/BE Anesthesiologist for a full-time, permanent, and employed position. You will be joining a team of 17 providers. · General anesthesiology, no hearts required, no OB (CRNA's) · The facility has 19 OR's and 7 GI Suites · NO VISA SUPPORT ...
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Urgent Neurology Physician Job in West Texas
2 weeks ago
Hayman Daugherty Associates, Inc San Antonio, United StatesJob Overview · Looking for BC/BE neurologists to join 3 general neurologists in their outpatient clinic and inpatient consults at the affiliated hospital. This is an employed, full-time position offering competitive compensation plus quality and production incentives along with f ...
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UnitedHealth Group Inc San Angelo, TX, United StatesRegistered Nurse RN Case Manager ICM West Texas · 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 hea ...
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Lead Production
3 days ago
Goodwill-West Texas San Angelo, United States: · Responsible for maintaining DSU production flow and meeting or exceeding production goals. Maintain a safe and clean work site and promote guidelines and processes. Works with DSU manager in supervising and providing training opportunities to employees. · Requirements: · • ...
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Facilities Assistant
3 weeks ago
West Texas Boys Ranch San Angelo, United StatesJob Description · Job DescriptionSalary: 28, ,000 · JOB TITLE: Facilities Assistant · TYPE: Salaried; Nonexempt · SUPERVISOR: Facilities Director · JOB SUMMARY · Responsible for assisting the Facilities Director with proper maintenance of the physical plant of West Texas Boys Ran ...
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Cottage Parents
3 weeks ago
West Texas Boys Ranch San Angelo, United StatesJob Description · Job DescriptionSalary: $52,000-55,000/couple/year · JOB SUMMARY · Opening is for a couple: · As the primary care provider, establish and maintain a healthy family environment with boys in need. Demonstrate commitment, acceptance, friendship, affection and respec ...
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Registered Nurse
1 day ago
West Texas Rehab Center San Angelo, United StatesRegistered Nurse - Hospice of San Angelo · Seeking full time RN to provide total care for those at the end of life.?This position provides skilled nursing care and participates in interdisciplinary care. This position requires good listening and communication skills, along with t ...
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LVN - Hospice of San Angelo
3 weeks ago
West Texas Rehab Center San Angelo, United StatesThis position provides skilled nursing care under the supervision of a Registered Nurse. Participates in interdisciplinary care. The LVN position requires good listening and communication skills, along with the capability in assimilating seemingly unrelated activities into a cohe ...
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Chaplain - Hospice of San Angelo
3 weeks ago
West Texas Rehab Center San Angelo, United StatesWorking as a member of the Hospice Team, the Chaplain will present a pastoral element of care and concern, providing spiritual and emotional support for patients, families, and staff members of all creeds. ...
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Farm and Ranch Coordinator
3 weeks ago
West Texas Boys Ranch San Angelo, United StatesJob Description · Job DescriptionSalary: · JOB TITLE: Farm & Ranch Coordinator · TYPE: Salaried; Non-Exempt · SUPERVISOR: Program Director – WTBR · JOB SUMMARY · Work with cottage staff and children in care to ensure maximum growth in all aspects of a boy's life. · Responsible ...
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Certified Nurse Aide
3 weeks ago
West Texas Rehab Center San Angelo, TX, United StatesThis position provides personal care for the patient, and activities of daily living and performs incidental household services. This takes place under the supervision of an RN. Organization and planning is necessary, along with the ability to explain plans and goals to others. T ...
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Single Cottage Parent
3 weeks ago
West Texas Boys Ranch San Angelo, United StatesJob Description · Job DescriptionSalary: · JOB SUMMARY · As the primary care provider, establish and maintain a healthy family environment for girls in need. Demonstrate commitment, acceptance, friendship, affection and respect for children, consistent with the mission and goals ...
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Britt Medical Search San Angelo, TX, United StatesExciting opportunity for a BC/BE Gastroenterologist to practice with four other gastroenterologists in central west Texas. Over 400 providers and 35 sub-specialties offered for on-site referral. Share call with five other physicians. Facility is licensed for 600 beds. EPIC EMR. W ...
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Life Services Director I
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West Texas Boys Ranch San Angelo, United StatesJob Description · Job DescriptionSalary: 66, ,000 · JOB TITLE: Life Services Director I · TYPE: Salaried; Exempt · SUPERVISOR: Chief Operations Officer – WTBR · JOB SUMMARY · The Life Services Director I is responsible for the implementation of the approved family based model of ...
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Delivery Technician
3 weeks ago
West Texas Rehab Center San Angelo, TX, United StatesThis position is responsible for delivery of durable medical equipment to patients in our Hospice of San Angelo department. This position ensures the safe delivery and set up of equipment to a specific location. They are also responsible for keeping track of equipment in stock an ...
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Registered Nurse
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West Texas Rehabilitation Center San Angelo, TX, United StatesWTRC offers a variety of benefits that few can match, including but not limited to: · Sign-on Bonus · Relocation assistance · Health, dental, and vision insurance · Matching 401K · Competitive salary · Paid continuing education and staff development opportunities · Paid Time Off ...
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lvn - hospice of san angelo
1 week ago
The West Texas Rehabilitation Center San Angelo, United StatesUnder the supervision of an RN, the LVN provides skilled nursing care for the patient and implements the plan of care as initiated by the RN. Organization and planning are necessary, along with the ability to explain plans and goals to others and assimilate seemingly unrelated ac ...
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Employed Neurology Opening in Central Texas
3 weeks ago
Enterprise Medical San Angelo, United States Full timeEnterprise Medical Recruiting is assisting a hospital to recruit a new Neurologist to be part of their team The incoming will join an established group of 2 Neurologists, part of a 300-plus provider multi-specialty group. They have a 16-bed dedicated stroke unit with telemedicine ...
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Dayshift Hospitalist
3 weeks ago
AMN Healthcare, Inc. San Angelo, TX, United StatesJob Description & Requirements · Dayshift Hospitalist · StartDate: ASAP Ranked one of the best universities in the nation, Texas A&M and the highly reputable Shannon Medical Center seek an inaugural Internal Medicine Faculty for a clinician-educator opportunity. The incoming ph ...
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AMN Healthcare San Angelo, United StatesJob Description & Requirements · Inaugural Program Director, Internal Medicine Residency · StartDate: ASAP Pay Rate: $ $ · Ranked one of the best universities in the nation, Texas A&M and the highly reputable Shannon Medical Center seek an Inaugural Internal Medicine Program Dir ...
Registered Nurse RN Case Manager ICM West Texas - San Angelo, TX, United States - UnitedHealth Group Inc
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.
The Nurse Case Manager II (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.
Nurse Case Manager will identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a patients' action plan and/or discharge plan.
They will perform reviews of current inpatient services and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.
The Nurse Case Manager will 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 Nurse Case Manager will coordinate, or provide appropriate levels of care under the direct supervision of an RN Manager 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.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.If you are located in West Texas, you will have the flexibility to work remotely* as you take on some tough challenges.
Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health statusAt UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
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.
