Registered Nurse Outpatient Case Manager

1 week ago

Gonzales, Texas, United States Optum Full time
OptumCare Registered Nurse Outpatient Case Manager

We are seeking a skilled Registered Nurse Outpatient Case Manager to join our team in San Antonio, TX. As a member of our OptumCare team, you will play a vital role in delivering high-quality patient care and improving health outcomes.

Job Summary

The primary responsibility of the OP Case Manager is to identify, screen, track, monitor, and coordinate the care of members with multiple co-morbidities and/or psychosocial needs. You will interact and collaborate with an interdisciplinary care team to develop a comprehensive care plan and provide education to patients and their families.

Key Responsibilities
  • Conduct initial assessments within designated timeframes for members identified as having complex case management needs.
  • Collaborate with the interdisciplinary care team to establish an individualized care plan for members with interventions to assist the member in meeting short- and long-term goals.
  • Engage patients, families, and caregivers to ensure a well-coordinated care plan is established.
  • Identify member needs, develop care plans, and prioritize goals, using evidence-based practice to develop interventions while considering member barriers.
  • Make outbound calls to assess member health status, identify gaps or barriers in care plans.
  • Provide member education to assist with self-management goals.
  • Make referrals to outside sources.
  • Coordinate visits with PCPs and specialists as needed on a limited basis, perform visual assessments for skin checks on exposed skin, and conduct home safety evaluations.
  • Independently confer with Market MD Medical Directors and/or PCPs on a regular basis regarding Complex Care/High Risk Population members and participate in department huddles.
  • Enter timely and accurate data into designated care management applications and maintain audit scores of 95% or better monthly.
  • Adhere to organizational and departmental policies and procedures.
Requirements
  • Associate's degree in Nursing.
  • Current unrestricted Registered Nurse 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 acutely ill patients with multiple disease conditions.
  • 3+ years of managed care and/or case management experience.
  • Experience utilizing planning, organizing, conflict resolution, negotiating, and interpersonal skills.
  • Experience utilizing critical thinking skills, nursing judgment, and decision-making skills; must be able to prioritize, plan, and handle multiple tasks/demands simultaneously.
  • Knowledge of utilization management, quality improvement, and discharge planning.
  • Proficient with Microsoft Office applications, including Outlook, Word, and Excel.
  • Demonstrated ability to read, analyze, interpret information in medical records and health plan documents.
  • Demonstrated ability to problem solve and identify community resources.
  • Proven ability to stand, walk, or sit for long periods.
  • Access to reliable transportation.
Preferred Qualification
  • Experience working with psychiatric and geriatric patient populations.

We are 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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