RN Inpatient Case Manager Remote from West Texas

2 weeks ago

Lubbock, United States UnitedHealth Group Inc Full time
RN Inpatient Case Manager Remote from West Texas

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Inpatient Services Case Manager performs 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. If you are located in West TX, you'll enjoy the flexibility to work remotely *as you take on some tough challenges. Full-Time Telecommute Position: This position requires 25% travel onsite for work related meetings. Must have reliable transportation. Primary Responsibilities: * Independently collaborates effectively with Interdisciplinary care team (ICT) to establish an individualized transition plan for members * 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 * Performs expedited, standard, concurrent, and retrospective 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 guidelines for all authorizations * 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 information * Identifies member's level of risk by utilizing the Population Stratification tools and communicates during transition process the member's transition discharge plan with the ICT * Conducts a transition discharge assessment telephonically to identify member needs at time of transition to a lower level of care * Manages assigned case load in an efficient and effective manner utilizing time management skills * Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities * Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in department huddles * 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 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 and maintain hospital credentialing as indicated * Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines * Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms * Refers cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for complex case situations * Monitors for any quality concerns regarding member care and reports as per policy and procedure * Performs all other related 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 * Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment * 3+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions * Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel * Willing or ability to travel to an office setting or other company location for work related meetings up to 25% of the time * Reliable transportation Preferred Qualifications: * 2+ years of managed care and/ or case management experience * Experience working with psychiatric and geriatric patient populations * Bilingual (English/Spanish) language proficiency * Knowledge of utilization management, quality improvement, and discharge planning * Proven ability to read, analyze and interpret information in medical records, and health plan documents * Proven ability to problem solve and identify community resources * Proven ability to possess planning, organizing, conflict resolution, negotiating and interpersonal skills * Proven ability to utilize critical thinking skills, nursing judgement, and decision making skills * Proven ability to prioritize, plan, and handle multiple tasks/demands simultaneously * Proven ability to frequently required to stand, walk or sit for prolonged periods * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy 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. 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.

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