Remote Telephonic RN Case Manager – Texas

Requisition Number: 2189323
Job Category: Nursing
Primary Location: Irving, TX
(Remote considered)

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.   

WellMed provides concierge – level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient’s health. WellMed’s proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

The Case Manager is a participant in the collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs. This process includes medical, social, developmental, behavioral, financial, and educational intervention with focus on quality and cost-effective outcomes.

The RN Case Manager schedule is Monday – Friday, 8a – 5p, local time, no weekends, or holidays.

If you are located Texas, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: 

• Engage and provide care management to commercial patient populations identified from the Health Plan, clinical meetings, outlier reports, plan specific insights, and predictive modeling
• Complete Transition of Care follow up and assessment post discharge
• Provide care management telephonically
• Complete required assessments
• Create a personalized care plan for each patient involved in care management to resolve barriers to care, close quality gaps in care,  build additional education or contingency planning and engage with social support systems as appropriate
• Regularly interact with health plan clinical programs and clinical personnel for care coordination
• Complete all necessary care coordination and or assessment activities as outlined in the care plan
• At least monthly or as needed, attend telephonic patient care conferences/meetings with the clinic or health plan on assigned patients involved in care management
• Weekly and as needed, participate in internal JOC meetings for plan specific insights, best practices and intervention development
• Follow NCQA Care Management, Person Centered Medical Home and Accountable Care Organization accreditation standards
• Document all patient care activities into electronic database
• Meet required Key Performance Indicators
• Pass Quality Audit metrics
• Coordinate and cooperate with other members of the care management team
• Support team through onboarding and training of new hire members
• Perform other 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
• 3+ years of experience in a hospital, acute care or direct care setting
• Proficiency in Microsoft Office products including Access, Excel, Word, PowerPoint and Outlook
• Ability to attend occasional staff meetings onsite at the DSW office
• Access to highspeed internet and a distraction free workspace

Preferred Qualifications: 

• Case Management Certification (CCM)
• Managed care and/or care management experience
• Experience in completion of assessment, care plans, care coordination and issue resolution
• Electronic case management and medical record experience
• Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking.
• Knowledge of healthcare reimbursement, Utilization Management, discharge planning, Disease Management
• Intermediate knowledge of Commercial Plans, applicable state Department of Insurance regulations and health plans
• Knowledge of NCQA standards in Primary Care Medical Home and Care Management, as well as Accountable Care Organization
• Demonstrated ability to work remotely
• Patient engagement experience including solid telephonic motivational interviewing skills

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy