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 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.
If you are located in Houston, TX, you will have the flexibility to telecommute* as you take on some tough challenges. Must be based in Houston area and able to come into the office when needed.
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.
High School Diploma/GED
Current, unrestricted Texas or Compast State LPN/LVN license
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
Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
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
Skills in planning, organizing, conflict resolution, negotiation and interpersonal skills to work with autonomy in meeting case management goals and initiatives
The ability to work independently in accomplishing assignments, program goals and objectives
Excellent verbal and written skills
Physical & Mental Requirements:
Ability to lift up to 10 pounds
Ability to push or pull heavy objects using up to 25 pounds of force
Ability to sit for extended periods of time
Ability to stand for extended periods of time
Ability to use fine motor skills to operate office equipment and/or machinery
Ability to properly drive and operate a company vehicle
Ability to receive and comprehend instructions verbally and/or in writing
Ability to use logical reasoning for simple and complex problem solving
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors 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)
WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.