Case Manager

7 days ago


San Antonio, Texas, United States UnitedHealth Group Inc Full time
Job Summary

We are seeking a highly skilled Registered Nurse Case Manager to join our team at UnitedHealth Group Inc. As a Case Manager, you will play a critical role in identifying, screening, tracking, and coordinating the care of members with complex medical needs.

Key Responsibilities
  • Initial Assessments: Conduct thorough initial assessments within designated time frames for members identified as having complex case management needs, considering clinical, behavioral, social, environmental, and financial factors.
  • Care Planning: Collaborate with the interdisciplinary care team to establish individualized care plans for members with interventions to assist them in meeting short- and long-term goals.
  • Patient Engagement: Engage patients, families, and caregivers to ensure a well-coordinated care plan is established.
  • Interventions and Education: Identify member needs, develop care plans, and prioritize goals, utilizing evidence-based practice and considering member barriers, with guidance from medical directors and the Manager of Care Management.
  • Outbound Calls: 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.
  • Referrals and Coordination: Make referrals to outside sources, coordinate visits with primary care physicians and specialists, and conduct home safety evaluations.
  • Data Entry and Compliance: Enter timely and accurate data into designated care management applications and maintain audit scores of 90% or better on a monthly basis, adhering to organizational and departmental policies and procedures.
  • On-Call Assignments: Take on-call assignments as directed, maintaining current licensure to work in the state of employment.
Requirements
  • Education: Bachelor's degree in Nursing, or Associate's degree in Nursing combined with 2+ years of experience and/or Nursing Diploma.
  • Licensure: Current unrestricted Registered Nurse license, specific to the state of employment.
  • Certification: Case Management certification (CCM) or ability to obtain CCM within 12 months after the first year of employment.
  • Experience: 3+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions, and 2+ years of managed care and/or case management experience.
  • Skills: Proven knowledge of utilization management, quality improvement, and discharge planning, proficient with Microsoft Office applications, and ability to utilize critical thinking skills, nursing judgment, and decision-making skills.
Preferred Qualifications
  • Experience: Experience working with psychiatric and geriatric patient populations.
Physical Qualifications
  • Ability: Ability to frequently stand, walk, or sit for long periods.


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