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Registered Nurse Case Manager Specialized Clinical Programs WellMed San Antonio TX

Company: UnitedHealth Group
Location: New Braunfels
Posted on: March 15, 2020

Job Description:

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  Specialized Clinical Programs (SCP) Case Manager  may perform telephonic and/or face-to-face assessments including ongoing re-assessment, case planning, service coordination and monitoring of the services that eligible members with special needs receive. Collaborates with the member and other health care providers to facilitate member access to health and social services, foster adherence to efficient and cost-effective medical treatment regimens which enhance member’s health and well-being. Facilitates a proactive partnership with members to enhance and personalize management of health-related needs. Conducts comprehensive assessment of needs, continuous care plan development, coordination and evaluation of member’s services leading to the goal of equipping and empowering members and caregivers to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting. Also responsible for providing health education, coaching and treatment decision support for members. Participates in Interdisciplinary Team conferences (IDT) to review care plan and member progress on identified goals and interventions. The SCP Case Manager will work in partnership with an assigned Care Navigator. Primary Responsibilities: Ability to assess a complex population and interpret member needs and requirement Perform individual health risk questionnaires assists with individualized care plan design, documentation and implementation of care plan activity, transitions of care coordination, and evaluation of outcomes Perform initial review of member’s health records and current health status (e.g., health risk scores) to identify health risk and determine next steps Perform medication reconciliation Receive information from members about specific symptoms and answer questions Identifies the targeted high-risk population, and perform risk stratification Evaluate member data throughout the assessment process to identify inconsistencies and adherence to Evidence Based Guidelines Work to develop identified individualized interventions for members in care management Utilize Motivational Interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy Utilizes critical thinking skills to solve complex problems and/or conduct complex analyses Identify and prioritize gaps to develop plan of care to empower members to meet identified goals Collaborate with members to set their own goals and align care activities with those goals Monitor progress of goals, adjust care needs accordingly Provide treatment recommendations and ongoing monitoring and evaluation of members Make follow-up calls to ensure members receive the necessary services, resources and care plan created with their nurse Assure appropriate and complete data entry of all documentation per guidelines Establish effective collaboration, communication and coordination among all responsible parties of a member’s multidisciplinary health care team Collaborate with member’s primary care physician and other providers/specialists of any potential problems as they become evident. Ensure members receive the proper level of care via coordination, assessment and interpretation of needs and requirements. Provide specific disease self-management education to members face-to-face and telephonically Coaches, provides education on disease processes, obtain feedback, and guide members on interventions to improve health outcomes Responsible for meeting CMS, NCQA, and all other regulatory compliance requirements for CMS Special Needs Program (SNP) Model of Care Adheres to quality standards, HIPAA, confidentiality, company policies, procedures and reporting requirements Actively participates in quality assessment/performance improvement program Works with minimal guidance; seeking guidance on only the most complex tasks Performs all other related duties as assigned This is an office based position located at our office off of Northwest Parkway, 78249 in San Antonio, TX - Must be willing to perform face-to-face assessments as deemed necessary. 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 as directed 5+ years of managed care and/or care management experience 5+ years of clinical experience Knowledge of managed care, medical terminology Excellent verbal and written skills Proficiency in Microsoft Office products including Access, Excel, Word, PowerPoint and Outlook Skills in planning, organizing, conflict resolution, negotiation, critical thinking and interpersonal skills to work with autonomy Experience with CMS and NCQA requirements for Special Needs Programs Proficient experience in Medicare and Medicaid population The ability to work independently in accomplishing assignments, program goals and objectives Experience carrying caseload of members Preferred Qualifications: 10+ years of clinical experience 5+ years of case management experience - telephonic and/or face-to-face Certified Case Manager (CCM) Careers 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 350,000+ 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) 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Job Keywords: WellMed, Healthcare, Bilingual, Registered Nurse, Case Manager, Specialized Clinical Programs, Telephonic Special Needs Population, CMS, NCQA, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Texas, TX

Keywords: UnitedHealth Group, New Braunfels , Registered Nurse Case Manager Specialized Clinical Programs WellMed San Antonio TX, Other , New Braunfels, Texas

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