Registered Nurse RN Outpatient Case Manager McAllen Texas - Case Management
Company: UnitedHealth Group Inc
Location: Mcallen
Posted on: April 28, 2024
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Job Description:
Registered Nurse RN Outpatient Case Manager McAllen 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 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:
* 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
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:
* 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
Preferred Qualifications:
* Certified Diabetes Educator, or Certified Case Manager
* Experience working with psychiatric and geriatric patient
populations
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
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. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealth Group Inc, McAllen , Registered Nurse RN Outpatient Case Manager McAllen Texas - Case Management, Executive , Mcallen, Texas
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