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Registered Nurse RN Inpatient Case Manager Healthcare WellMed Texas /

UnitedHealth Group

This is a Full-time position in Pflugerville, TX posted February 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)n nThe Case Manager
– Inpatient Services performs onsite review or telephonic clinical review of inpatient admissions in an acute hospital, rehabilitation facility, LTAC or skilled nursing facility.

Actively implements a plan of care utilizing approved clinical guidelines to transition and 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 case manager is responsible for coordinating the care from admission through discharge.

The Case Manager participates in Patient Care Conferences to review clinical status, update/finalize transition discharge needs, and identify members at risk for readmission.n nPrimary Responsibilities:n n* In consultation with manager of Care Management collaborates with Interdisciplinary care team (ICT) to establish an individualized transition plan for membersn* Serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care with guidance from medical directors and Manager of Case Management Utilizing evidenced-based criteria within our documentation systemn* Performs expedited, standard, concurrent, and retrospective onsite or telephonic clinical reviews at in-network and/or out-of-network facilities.

The Case Manager documents medical necessity and appropriate level of care utilizing national recognized clinical guidelinesn* Interacts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit informationn* Identifies member”s level of risk by utilizing the Population Stratification tools and communicates during transition process the member”s transition discharge plan in consultation with the ICTn* Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of caren* Manages assigned case load with supervision in an efficient and effective manner utilizing time management skillsn* Demonstrates knowledge of utilization management and care coordination processes as a foundation for transition planning activitiesn* Confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in department huddlesn* Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 90% or better on a monthly basisn* Adheres to organizational and departmental policies and proceduresn* Takes on-call assignment as directed with supervisionn* The Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicatedn* Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelinesn* Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract termsn* Refers cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for complex case situationsn* Monitors for any quality concerns regarding member care and reports as per policy and proceduren* Performs all other related duties as assignedn* Saturday and Sunday Shifts requiredn nYou”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.n nRequired Qualifications:n n* Bachelor”s degree in Nursing and/or Associate”s degree in Nursing or Nursing Diploma combined with 2+ years of clinical experience above the required years of experiencen* Current, unrestricted RN license, specific to the state of employment or compact state licensen* Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employmentn* 3+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditionsn* 2+ years of managed care and/or case management experiencen* Knowledge of utilization management, quality improvement, and discharge planningn* Ability to read, analyze and interpret information in medical records, and health plan documentsn* Knowledgeable in Microsoft Office applications including Outlook, Word, and Exceln* Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated arean* You will be asked to perform this role in an office setting, however, may be required to work from home temporarily due to space limitationsn* 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 attainedn nCareers 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 550,000+ 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)n nDiversity 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.n nUnitedHealth Group is a drug-free workplace.

Candidates are required to pass a drug test before beginning employment.n nJob Keywords: WellMed, Healthcare, Bilingual, Registered Nurse, RN, Inpatient Case Manager, CM, Complex Care, Utilization Management, Hospital, Dallas, Fort Worth, Tampa, FL, Texas, TX nnby Jobblenn

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