Healthcare Manager for Chronic Care Coordination

4 days ago


Sugar Land, Texas, United States Optum Full time

At Optum, we're changing the face of healthcare for seniors. 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.

We're seeking a Registered Nurse RN Clinic Healthcare Manager to join our team in Houston, Texas. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. You'll have the clinical resources, data, and support of a global organization behind you so you can help your patients live healthier lives.

About the Role

The Healthcare Manager is responsible for successfully supporting patients with high-risk health conditions to navigate the healthcare system. You'll act as an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. Your interactions will be with multidisciplinary care teams, including physicians, nurses, pharmacists, laboratory technologists, social workers, and other educators. You'll also serve as a resource for clinic staff.

This role involves working in a less structured, self-directed environment, and you'll perform all nursing duties within the scope of a RN license of the applicable state board of nursing. The ideal candidate will have experience in a physician's office, clinical, or hospital setting and possess knowledge of chronic diseases, such as COPD/asthma, diabetes, CHF, and IHD.

Key Responsibilities
  • Work with providers and clinic staff to identify patients at high risk telephonically primarily.
  • Support longitudinal care of the patient with chronic care conditions by:
    • Performing assessment of health conditions.
    • Performing medication reconciliation.
    • Conducting Motivational Interviewing and Self-Management Goal setting.
    • Providing patient education, creating referrals to appropriate agencies and resources.
  • Support transition of the patient with chronic care conditions from inpatient to outpatient setting by:
    • Performing assessment of transitional needs.
    • Performing medication reconciliation.
    • Establishing and reviewing contingency plan.
    • Providing patient education.
    • Assisting with post-discharge needs such as prescriptions, transportation, Durable Medical Equipment (DME), appointments.
  • Coordinate with providers to establish or update plan of care.
  • Perform accurate and timely documentation in the electronic medical record.
  • Participate in daily huddles and Patient Care Coordination (PCC) meetings.
  • Prepare accurate and timely reports, as required, for weekly meetings.
  • Maintain continued competence in nursing practice and knowledge of current evidence-based practices.

This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease.

Qualifications
  • Bachelor's degree in Nursing or Associate's degree in Nursing with two or more years of experience.
  • Registered Nurse with an active and unrestricted license to practice in the state of employment.
  • Current BLS certification.
  • 2+ years of experience in a physician's office, clinical, or hospital setting.
  • Knowledge of chronic diseases, COPD/asthma, diabetes, CHF, and IHD.
  • Proficient computer skills to work efficiently with electronic medical records.


  • Sugar Land, Texas, United States Always Best Care Senior Service Full time

    Always Best Care Senior Service is a leading provider of home healthcare services, dedicated to helping seniors maintain their independence and live life to the fullest. We are seeking a compassionate and experienced Registered Nurse to join our team as a Care Coordinator.**Job Description:**In this role, you will be responsible for coordinating home health...


  • Sugar Land, Texas, United States Houston Methodist Full time

    About the RoleWe are seeking a highly motivated and organized individual to fill the position of Healthcare Mobility Coordinator. As a key member of our transportation team, you will be responsible for coordinating the safe and efficient movement of patients throughout the hospital. Your primary responsibilities will include:Key ResponsibilitiesCoordinating...


  • Sugar Land, Texas, United States Serenity Healthcare Full time

    Job OverviewSerenity Healthcare is seeking a dedicated Patient Experience Coordinator to join our team. As a key member of our healthcare staff, you will play a vital role in delivering exceptional patient care and experiences.In this full-time position, you will be responsible for ensuring a smooth and seamless patient journey, from initial contact to the...


  • Sugar Land, Texas, United States Serenity Healthcare Full time

    Join Our Team of Care ProfessionalsSerenity Healthcare is committed to providing patients with access to innovative healing technologies like TMS and Ketamine.We are seeking an Experience Delivery Coordinator for our San Antonio office. As an Experience Delivery Coordinator, you will work closely with patients to understand their needs and deliver...


  • Sugar Land, Texas, United States Fresenius Medical Care Full time

    Company OverviewFresenius Medical Care is a leading provider of renal therapies, committed to improving the lives of patients worldwide. Our team is dedicated to delivering innovative products and services that make a meaningful difference in the healthcare landscape.Job DescriptionWe are seeking a skilled Patient Educator to join our Home Therapies team. As...


  • Sugar Land, Texas, United States Sonida Senior Living Full time

    Sonida Senior Living, a leading provider of senior living services, is seeking a compassionate and detail-oriented Senior Care Coordinator to join our team at 831 E Washington Street.Job OverviewWe are looking for an individual with strong communication and interpersonal skills to assist residents with daily living activities, administer medications and...


  • Sugar Land, Texas, United States Care Options for Kids Full time

    At Care Options for Kids, we are passionate about providing exceptional care to children and families. As a Children's Developmental Care Provider, you will play a crucial role in helping us achieve this mission.Job Responsibilities* Conduct occupational therapy sessions with children in their homes or other settings* Develop and implement treatment plans...


  • Sugar Land, Texas, United States PrimeFlight Aviation Services Full time

    Airline Revenue Management CoordinatorPrimeFlight Aviation Services is a leading provider of commercial services within the aviation industry. As an Airline Revenue Management Coordinator, you will play a crucial role in ensuring the accuracy and timeliness of billing transactions related to airport services.Key Responsibilities:Verify billing terms and...


  • Sugar Land, Texas, United States Serenity Healthcare Full time

    Job SummaryWe are seeking a dedicated Therapy Support Coordinator to join our team at Serenity Healthcare. As a Therapy Support Coordinator, you will play a critical role in supporting patients during TMS therapy and collaborating with our clinical team to optimize patient outcomes.About the RolePrepare and administer TMS treatments with precision and...


  • Sugar Land, Texas, United States Always Best Care Senior Services Full time

    Join Our Team: If you are a compassionate and caring Registered Nurse looking for a challenging and rewarding career opportunity, we encourage you to apply for this position.Job Title: Healthcare Team Member - Home Health RNJob Summary: As a Healthcare Team Member, you will play a critical role in delivering high-quality care to our clients and their...


  • Sugar Land, Texas, United States Froedtert Memorial Lutheran Hospital Full time

    Job Summary">We are seeking a dedicated Certified Nursing Assistant (CNA) to join our team at Froedtert Memorial Lutheran Hospital. As a CNA, you will play a vital role in supporting our nursing staff in providing high-quality patient care.">About the Position">This is an exciting opportunity to work in a dynamic and supportive environment where you can grow...


  • Sugar Land, Texas, United States Houston Methodist Full time

    Clinical Services Coordinator Job SummaryThis Clinical Services Coordinator position provides critical support to our clinical teams, enabling them to deliver high-quality patient care. The ideal candidate will possess strong organizational and communication skills, with a passion for delivering exceptional patient experiences.Main ResponsibilitiesCoordinate...


  • Sugar Land, Texas, United States Serenity Healthcare Full time

    Job Overview:Serenity Healthcare is seeking a dedicated and compassionate Patient Experience Coordinator to join our team in Sugar Land, TX. This full-time role offers a unique opportunity to make a positive impact on the lives of our patients.The ideal candidate will possess excellent communication and interpersonal skills, with the ability to multitask in...


  • Sugar Land, Texas, United States Houston Methodist Full time

    About the PositionWe are seeking a highly skilled and experienced Perioperative Care Coordinator to join our team at Houston Methodist Sugar Land Hospital. This role is responsible for leading the patient and family-centered care standards, coordinating activities that align the surgeon and their schedule for efficiency and effectiveness, and maintaining...


  • Sugar Land, Texas, United States beBee Professionals Full time $85,000 - $110,000

    About beBee ProfessionalsWe are a dynamic healthcare organization seeking an experienced Advanced Clinical Care Specialist to join our team in Sugar Land.Job SummaryThis role involves providing high-quality patient care, including diagnosis, treatment, and health education. The ideal candidate will possess strong clinical skills, excellent communication...


  • Sugar Land, Texas, United States Always Best Care Senior Service Full time

    Join our team of dedicated professionals at Always Best Care Senior Service and take your career to the next level as a Skilled Home Healthcare Provider. In this role, you will be responsible for coordinating home health clinical services under the direction of local staff and ensuring the quality, continuity, and delivery of skilled service to seniors in...


  • Sugar Land, Texas, United States Care Options for Kids Full time

    At Care Options for Kids, we're dedicated to delivering high-quality pediatric services that empower children and families to thrive. As a Physical Therapist on our team, you'll play a vital role in shaping the future of pediatric healthcare.About UsCare Options for Kids is the leading provider of pediatric home therapy services, with a strong commitment to...


  • Sugar Land, Texas, United States NP Now Full time

    About the OpportunityA growing health system in Houston, TX is seeking a skilled Pain Management Specialist to join its team. This is an exciting opportunity for a physician to make a meaningful difference in the lives of patients.The ideal candidate will have experience in managing chronic pain and a strong background in interventional pain procedures. The...


  • Sugar Land, Texas, United States Privia Medical Group Full time

    Job SummaryWe are seeking a highly skilled and experienced physician assistant to join our primary care practice in Sugar Land, TX.Key Responsibilities:Provide exceptional patient care to adult patients, with a focus on acute and chronic conditions.Manage patient charts efficiently and accurately, with a goal of completing documentation within 24-48...


  • Sugar Land, Texas, United States New Perspective Full time

    Job Title: Senior Scheduling Coordinator Estimated Salary: $45,000 - $60,000 per year At New Perspective, we are seeking a highly organized and detail-oriented Senior Scheduling Coordinator to join our team. In this role, you will be responsible for maintaining the schedule for our care team department, ensuring that vacant shifts are filled to meet...