Registered Nurse Case Manager PHM
Company: Optum
Location: Cibolo
Posted on: March 5, 2025
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Job Description:
WellMed, part of the Optum family of businesses, is seeking a
Registered Nurse Case Manager PHM to join our team in Austin and
San Antonio, TX. Optum is a clinician-led care organization that is
changing the way clinicians work and live. -
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.---
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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.
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If you have a compact license and located in the following areas -
Austin, San Antonio, TX, -you will have the flexibility to work
remotely* as you take on some tough challenges.
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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
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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 with in 2 hours of Austin or San Antonio, TX
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Preferred Qualifications: -
Experience working with psychiatric and geriatric patient
populations
Knowledgeable in Microsoft Office applications including Outlook,
Word, and Excel 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
Bilingual in Spanish -
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*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy.
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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.
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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.
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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.
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UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: Optum, New Braunfels , Registered Nurse Case Manager PHM, Healthcare , Cibolo, Texas
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