RN Case Manager Telecommute WellMed

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

The Specialized Clinical Programs (SCP) Case Manager will perform telephonic assessments including ongoing re-assessment, case planning, service coordination and monitoring of the services that eligible members with special needs receive. Collaborates with the member and other health care providers to facilitate member access to health and social services, foster adherence to efficient and cost-effective medical treatment regimens which enhance member’s health and well-being. Facilitates a proactive partnership with members to enhance and personalize management of health-related needs. Conducts comprehensive assessment of needs, continuous care plan development, coordination and evaluation of member’s services leading to the goal of equipping and empowering members and caregivers to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting. Also responsible for providing health education, coaching and treatment decision support for members. Participates in Interdisciplinary Team conferences (IDT) to review care plan and member progress on identified goals and interventions. The SCP Case Manager will work in partnership with an assigned Care Navigator.

There is a $2,500 Sign On Bonus for bilingual candidates. (Spanish or Vietnamese)

Telecommuting is an option. However, you must meet and maintain quality and productivity expectations, this is an ongoing requirement. M ust be within commuting distance of either the San Antonio office (5800 NW Parkway San Antonio TX 78249) or the Houston office (1200 Binz Street, Suite 1200, Houston, TX 77004)

Primary Responsibilities:

• Ability to assess a complex population and interpret member needs and requirement
• Perform individual health risk questionnaires assists with individualized care plan design, documentation and implementation of care plan activity, transitions of care coordination, and evaluation of outcomes
• Perform initial review of member’s health records and current health status (e.g., health risk scores) to identify health risk and determine next steps
• Perform medication reconciliation
• Receive information from members about specific symptoms and answer questions
• Identifies the targeted high-risk population, and perform risk stratification
• Evaluate member data throughout the assessment process to identify inconsistencies and adherence to Evidence Based Guidelines
• Work to develop identified individualized interventions for members in care management
• Utilize Motivational Interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
• Utilizes critical thinking skills to solve complex problems and/or conduct complex analyses
• Identify and prioritize gaps to develop plan of care to empower members to meet identified goals
• Collaborate with members to set their own goals and align care activities with those goals
• Monitor progress of goals, adjust care needs accordingly
• Provide treatment recommendations and ongoing monitoring and evaluation of members
• Make follow-up calls to ensure members receive the necessary services, resources and care plan created with their nurse
• Assure appropriate and complete data entry of all documentation per guidelines
• Establish effective collaboration, communication and coordination among all responsible parties of a member’s multidisciplinary health care team
• Collaborate with member’s primary care physician and other providers/specialists of any potential problems as they become evident.
• Ensure members receive the proper level of care via coordination, assessment and interpretation of needs and requirements. Provide specific disease self-management education to members face-to-face and telephonically
• Coaches, provides education on disease processes, obtain feedback, and guide members on interventions to improve health outcomes
• Responsible for meeting CMS, NCQA, and all other regulatory compliance requirements for CMS Special Needs Program (SNP) Model of Care
• Adheres to quality standards, HIPAA, confidentiality, company policies, procedures and reporting requirements
• Actively participates in quality assessment/performance improvement program
• Works with minimal guidance; seeking guidance on only the most complex tasks
• 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:

• Current, unrestricted RN license, specific to the state of employment including ability to obtain additional state licenses as directed
• 5+ years of managed care and/or care management experience
• 5+ years of clinical experience
• Knowledge of managed care, medical terminology
• Excellent verbal and written skills
• Proficiency in Microsoft Office products including Access, Excel, Word, PowerPoint and Outlook
• Skills in planning, organizing, conflict resolution, negotiation, critical thinking and interpersonal skills to work with autonomy
• Proficient experience in Medicare and Medicaid population
• The ability to work independently in accomplishing assignments, program goals and objectives
• Experience carrying caseload of members
• You will be required to adhere to UnitedHealth Group’s US Telecommuting Policy
• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications:

• 10+ years of clinical experience
• 5+ years of case management experience - telephonic and/or face-to-face
• Certified Case Manager (CCM)
• Experience with CMS and NCQA requirements for Special Needs Programs
  

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors., WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for 550,000+ older adults with over 16,000 doctors’ offices 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)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

**PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.

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: WellMed, Healthcare, Bilingual, Registered Nurse, Case Manager, Specialized Clinical Programs, Telephonic Special Needs Population, CMS, NCQA, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Texas, TX