Registered Nurse Outpatient Case Manager

6 days ago


San Antonio, Texas, United States UnitedHealth Group Full time
Job Title: Registered Nurse Outpatient Case Manager

We are seeking a highly skilled Registered Nurse Outpatient Case Manager to join our team in San Antonio, TX. As a member of our Optum Care Delivery team, you will play a vital role in making healthcare better for everyone.

About the Role:

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, including physicians, inpatient case managers, care team associates, pharmacists, social workers, educators, and healthcare coordinators/managers.

Key Responsibilities:
  • Conduct initial assessments within designated timeframes for members identified as having complex case management needs.
  • Collaborate effectively with the IDT 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 independently.
  • 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.
About Us:

WellMed is a network of doctors, specialists, and other medical professionals that specialize in providing care for more than 1 million older adults. At WellMed, our focus is simple: we're innovators in preventative healthcare, striving to change the face of healthcare for seniors. We believe in diversity and inclusion, and we're committed to making healthcare better for everyone.

We're part of the UnitedHealth Group, a global organization that's changing the face of healthcare. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.


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