Clinical Case Manager
2 weeks ago
We are seeking a highly skilled Registered Nurse Case Manager to join our team at WellMed, part of the Optum family of businesses. As a Case Manager, you will play a critical role in identifying, screening, tracking, and coordinating the care of members with multiple co-morbidities and/or psychosocial 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 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, utilizing evidence-based practice and considering member barriers with guidance from medical directors and Manager of Care Management.
- 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 with guidance from medical directors and Manager of Care Management.
- Coordinate visits with PCPs and specialists on a limited basis, perform visual assessments for skin checks on exposed skin, and conduct home safety evaluations.
- Enter timely and accurate data into designated care management applications and maintain audit scores of 90% or better on a monthly basis.
- Adhere to organizational and departmental policies and procedures.
- Take on-call assignments as directed.
- Maintain current licensure to work in the state of employment.
- Bachelor's degree in Nursing, and/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 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.
- Experience working with psychiatric and geriatric patient populations.
- Ability to frequently stand, walk, or sit for long periods.
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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