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Registered Nurse Case Manager

2 months ago

Gonzales, Texas, United States Optum Full time
Case Manager RN Opportunity at Optum

We are seeking a skilled Registered Nurse Case Manager to join our team at Optum in San Antonio, TX. As a Case Manager RN, you will play a critical role in identifying, screening, tracking, and coordinating the care of members with complex needs.

Key Responsibilities:
  • Conduct initial assessments within designated time frames for members identified as having complex case management needs.
  • Collaborate effectively with the interdisciplinary care team to establish individualized care plans and interventions.
  • Engage patients, families, and caregivers to ensure well-coordinated care plans are established.
  • Identify member needs, develop care plans, and prioritize goals, utilizing evidence-based practice and considering member barriers.
  • Make outbound calls to assess member health status, identify gaps or barriers in care plans, and provide member education to assist with self-management goals.
  • Make referrals to outside sources and educate members on disease processes or acute conditions, providing indicated contingency plans.
  • Coordinate visits with PCPs and specialists, perform visual assessments, and conduct home safety evaluations.
  • Enter timely and accurate data into designated care management applications and maintain audit scores of 90% or better.
  • Adhere to organizational and departmental policies and procedures.
  • Take on-call assignments as directed.
Requirements:
  • Bachelor's degree in Nursing, or Associate's degree in Nursing combined with 2+ years of experience and/or Nursing Diploma.
  • 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.
  • 2+ years of managed care and/or case management experience.
  • Proven knowledge of utilization management, quality improvement, and discharge planning.
  • Proficient with Microsoft Office applications, including Outlook, Word, and Excel.
  • Proven ability to utilize critical thinking skills, nursing judgment, and decision-making skills, prioritizing, planning, and handling multiple tasks/demands simultaneously.
  • Proven ability to read, analyze, interpret information in medical records and health plan documents.
  • Proven ability to problem-solve and identify community resources.
  • Proven planning, organizing, conflict resolution, negotiating, and interpersonal skills.
  • Access to reliable transportation to travel to client and/or patient sites within a designated area.
  • This position requires Tuberculosis screening and 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.
Preferred Qualification:
  • Experience working with psychiatric and geriatric patient populations.
Physical Qualification:
  • Ability to frequently stand, walk, or sit for long periods.