Registered Nurse Case Manager PHM
Company: Optum
Location: Euless
Posted on: March 5, 2025
|
|
|
Job Description:
WellMed, part of the Optum family of businesses, is seeking a
Registered Nurse Case Manager PHM to join our team in Dallas, Fort
Worth and Waco, TX. Optum is a clinician-led care organization that
is changing the way clinicians work and live. -
As a member of the Optum Care Delivery team, you'll be an integral
part of our vision to make healthcare better for everyone. -
At Optum, you'll have the clinical resources, data and support of a
global organization behind you so you can help your patients live
healthier lives. Here, you'll work alongside talented peers in a
collaborative environment that is guided by diversity and inclusion
while driving towards the Quadruple Aim. We believe you deserve an
exceptional career, and will empower you to live your best life at
work and at home. Experience the fulfillment of advancing the
health of your community with the excitement of contributing new
practice ideas and initiatives that could help improve care for
millions of patients across the country. Because together, we have
the power to make health care better for everyone. Join us and
discover how rewarding medicine can be while Caring. Connecting.
Growing together.--- -
The PHM 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 have a compact license and located in the following areas -
Dallas, Fort Worth, or Waco, TX, you will have the flexibility to
work remotely* as you take on some tough challenges. -
Primary Responsibilities:
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
Utilizing evidenced-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
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
Performs all other related duties as assigned
In 2011, WellMed partnered with Optum to provide care to patients
across Texas and Florida. WellMed is a network of doctors,
specialists and other medical professionals that specialize in
providing care for more than 1 million older adults with over
16,000 doctors' offices. At WellMed our focus is simple. We're
innovators in preventative health care, striving to change the face
of health care for seniors. WellMed has more than 22,000+ primary
care physicians, hospitalists, specialists, and advanced practice
clinicians who excel in caring for 900,000+ older adults. Together,
we're making health care work better for everyone. -
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:
Associate's degree in Nursing
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 diverse clinical experience, preferably in caring for
the acutely ill patients with multiple disease conditions
3+ years of managed care and/or case management experience
Proven knowledge of utilization management, quality improvement,
and discharge planning -
Live within 2 hours of Dallas, Fort Worth, or Waco, TX
Preferred Qualifications:
Experience working with psychiatric and geriatric patient
populations
Knowledgeable in Microsoft Office applications including Outlook,
Word, and Excel
Proven ability to read, analyze and interpret information in
medical records, and health plan documents
Demonstrated ability to problem solve and identify community
resources
Demonstrated ability to prioritize, plan, and handle multiple
tasks/demands simultaneously
Proven planning, organizing, conflict resolution, negotiating and
interpersonal skills
Proven 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 -
The salary range for this role is $59,500 to $116,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives. -
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. -
Keywords: Optum, Euless , Registered Nurse Case Manager PHM, Executive , Euless, Texas
|
Click
here to apply!
|
