Job Description

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 Inpatient Case Manager 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.

This role will require onsite rounding at the North Austin and Round Rock, TX skilled nursing facilities. This is an 8am-5pm CST Monday-Friday role with weekend at home telephonic on call duties every 5th week

Primary Responsibilities:

* 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.

Required Qualifications:

* Current, unrestricted RN license required, specific to the state of employment
* Three or more years of diverse clinical experience; preferred in caring for the acutely ill patients with multiple disease conditions
* Three or more years of managed care and/or case management experience
* Knowledge of utilization management, quality improvement, and discharge planning
* Must have reliable transportation and maintain an active driver's license
* Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
* You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
* Employees are 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 prior to entering the work site each day, in order to keep our work sites safe. 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:

* Experience working with psychiatric and geriatric patient populations
* Bilingual (English/Spanish) language proficiency
* Ability to read, analyze and interpret information in medical records, and health plan documents
* Ability to problem solve and identify community resources
* Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
* Independently utilizes critical thinking skills, nursing judgement and decision-making skills
* Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously
* Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel

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.

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 380,000+ 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

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: RN Case Manager, utilization management, UM, RN, Registered Nurse, Nurse, Nursing, BSN, Austin, TX, Texas