Clinical Case Manager
2 weeks ago
We are seeking a 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.
Key Responsibilities- Conduct initial assessments for members with complex case management needs, identifying clinical, behavioral, social, environmental, and financial factors.
- Collaborate with the interdisciplinary care team to establish individualized care plans, prioritizing goals and interventions.
- 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.
- 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, educate members on disease processes or acute conditions, and provide indicated contingency plans.
- Coordinate visits with PCPs and specialists as needed, perform visual assessments for skin checks on exposed skin, and conduct home safety evaluations.
- Enter timely and accurate data into designated care management applications, maintaining audit scores of 95% or better monthly.
- Adhere to organizational and departmental policies and procedures.
- 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, prioritizing, planning, and handling 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.
WellMed, part of the Optum family of businesses, is a network of doctors, specialists, and other medical professionals dedicated to providing care for older adults. We are innovators in preventative healthcare, striving to change the face of healthcare for seniors.
At WellMed, we believe in the importance of diversity and inclusion, creating a healthier atmosphere for our employees and patients. We are an Equal Employment Opportunity/Affirmative Action employer and welcome qualified applicants from all backgrounds.
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