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Registered Nurse Case Manager SNF Healthcare WellMed San Antonio TX

UnitedHealth Group

This is a Full-time position in Floresville, TX posted June 3, 2021.

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 primary responsibility of the Case Manager is to identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a case management care plan.

They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers,  educators, health care coordinators/managers.

The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence.

The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions.

The Case Manager may perform telephonic and/or face-to-face assessments.


Primary Responsibilities:

In consultation with manager of Care Management, conducts initial assessments within designated time frames for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
In consultation with manager of Care Management collaborates effectively with IDT to establish an individualized care plan for members with interventions to assist the member in meeting short and long term goals
Engage patient, family, and caregivers to assure that a well-coordinated care plan is established.

Will identify member needs, develop care plan and prioritize goals; using evidence based practice the Case Manager will develop interventions while considering member barriers with guidance from medical directors and Manager of Care Management
Make outbound calls to assess member health status, identify gaps or barriers in care plan
Provide member education to assist with self-management goals
Make referrals to outside sources
Educate members on disease process or acute condition and provide indicated contingency plan with guidance from medical directors and Manager of Care Management
Coordinates visits with PCP and specialists on a limited basis, performs visual assessment for skin checks on exposed skin, and conducts home safety evaluation
Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a monthly basis
Adheres to organizational and departmental policies and procedures
Takes on-call assignment as directed

The Case Manager will also maintain current licensure to work in state of employment.

Decision making is based on regulatory requirements, policies and procedures, and current clinical guidelines
Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms

Monitors for quality concerns regarding member care and reports as per policy and procedure.

Performs all other related duties as assigned

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