Registered Nurse Inpatient Case Manager Healthcare WellMed San Antonio Texas
1 month ago
Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
The Case Manager II - Inpatient Services performs onsite review or telephonic clinical review of inpatient admissions in an acute hospital, rehabilitation facility, LTAC or skilled nursing facility. Actively implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate lower level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The case manager is responsible for coordinating the care from admission through discharge. The Case Manager participates in Patient Care Conferences to review clinical status, update/finalize transition discharge needs, and identify members at risk for readmission.
Primary Responsibilities:
Independently collaborates effectively with Interdisciplinary care team (ICT) to establish an individualized transition plan for membersIndependently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria within our documentation systemPerforms expedited, standard, concurrent, and retrospective onsite or telephonic clinical reviews at in network and/or out of network facilities. The Case Manager documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines for all authorizationsInteracts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information Identifies member’s level of risk by utilizing the Population Stratification tools and communicates during transition process the member’s transition discharge plan with the ICTConducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of careManages assigned case load in an efficient and effective manner utilizing time management skillsDemonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activitiesIndependently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in department huddlesEnters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 95% or better on a monthly basisAdheres to organizational and departmental policies and proceduresTakes on-call assignment as directedThe Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicatedDecision-making is based on regulatory requirements, policy and procedures and current clinical guidelinesMaintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract termsRefers cases to UM Medical Director as appropriate for review for cases not meeting medical necessity criteria or for complex case situationsMonitors for any quality concerns regarding member care and reports as per policy and procedurePerforms all other related duties as assignedFull-Time Office-IH10W/Field Base/Hybrid Position: This position requires 25% - 50% traveling around the San Antonio, TX, and counties areas: Performing onsite review/telephonic clinical reviews of inpatient admissions in an acute hospital, rehabilitation facility, LTAC or skilled nursing facility. Required rotating on-calls (2 - 3 weekends per year)
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Bachelor’s degree in Nursing and/or, Associate’s degree in Nursing combined with 4+ years of experience above the required years of experienceCurrent, unrestricted RN license, specific to the state of employmentCase Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment4+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions3+ years of managed care and/ or case management experienceKnowledge of utilization management, quality improvement, and discharge planningKnowledgeable in Microsoft Office applications including Outlook, Word, and ExcelProven ability to read, analyze and interpret information in medical records, and health plan documentsProven ability to problem solve and identify community resourcesProven ability to frequently to stand, walk or sit for prolonged periodsAccess to reliable transportation 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 diseasePreferred Qualifications:
Experience working with psychiatric and geriatric patient populationsBilingual (English/Spanish) language proficiencyProven ability to utilize critical thinking skills, nursing judgement, and decision making skillsProven ability to prioritize, plan, and handle multiple tasks/demands simultaneouslyProven ability to planning, organizing, conflict resolution, negotiating and interpersonal skillsPhysical & Mental Requirements:
Ability to lift up to 25 pounds Ability to push or pull heavy objects using up to 10 pounds of force Ability to sit for extended periods of time Ability to stand for extended periods of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solvingAt UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
-
Texas Deputy Field Organizer
2 days ago
Boerne, United States NextGen America Full timeJob DescriptionJob DescriptionSalary: $22.44/hourTexas Deputy Field Organizer (San Antonio):THE ROLE: NextGen America is seeking passionate and hardworking candidates to join our youth organizing program in Texas, working to engage young people in electoral politics by registering thousands of young people to vote across the state. NextGen is committed to...
-
Registered Nurse Renal Case Manager Texas
3 weeks ago
Boerne, United States UnitedHealth Group Full timeFor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.The Renal Nurse Case Manager II (NCM) is responsible for patient case management for longitudinal engagement, coordination for...
-
Registered Nurse
4 weeks ago
Boerne, United States Capitol Home Health - ClinicalField Full timeJob DescriptionJob DescriptionWHY JOIN US?Capitol Home Health is a family-owned and operated healthcare agency that is proud to serve Central Texas. We have offices in Austin, Temple and San Antonio. We have earned the ACHC accreditation, the gold star standard in the healthcare industry, demonstrating that quality patient care is the core value of our...
-
Boerne, United States UnitedHealth Group Full timeFor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.The Clinical Team Manager is an RN position who performs management/ supervision functions in coordination of all clinical...
-
Boerne, United States UnitedHealth Group Full timeFor those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.The Clinical Team Manager is an RN position who performs management/ supervision functions in coordination of all clinical...
-
Freestanding Emergency Center Registered Nurse
4 weeks ago
Boerne, Texas, United States HCA Healthcare Full timeDescription IntroductionDo you want to join an organization that invests in you as a(an) Freestanding Emergency Center Registered Nurse? At Methodist ER Boerne, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years.BenefitsMethodist ER Boerne, offers a total rewards...
-
Freestanding Emergency Center Registered Nurse
1 month ago
Boerne, Texas, United States HCA Healthcare Full timeDescription IntroductionDo you want to join an organization that invests in you as a(an) Freestanding Emergency Center Registered Nurse? At Methodist ER Boerne, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three years.BenefitsMethodist ER Boerne, offers a total rewards...
-
Director 1, Healthcare Technology Management
2 weeks ago
Boerne, Texas, United States Sodexo Full timeUnit Description:Lifesaving technology, powered by you. Your expertise impacts the lives of others.FULL RELOCATION Package or Sign-on Bonus is INCLUDEDSodexo's growing Healthcare Technology Management (HTM) Division is currently seeking an HTM Director for UT Health, a well-respected & prestigious healthcare system located in San Antonio, TX. The Director...
-
Pool Maintenance Technician
4 weeks ago
Boerne, United States Blue Science Pools Full timeJob DescriptionJob DescriptionBlue Science is one of America’s largest, most experienced, and most awarded pool service companies. We service customers in all the major Texas and Florida Metro Areas. Blue Science, founded in 2007, is family owned and operated, with a strong commitment to bringing our customers pool care and craftsmanship they can rely on...
-
Freestanding Emergency Room Registered Nurse
4 weeks ago
Boerne, Texas, United States HCA Healthcare Full timeDescription IntroductionDo you have the career opportunities as a(an) Freestanding Emergency Room Registered Nurse you want with your current employer? We have an exciting opportunity for you to join Methodist ER Boerne which is part of the nations leading provider of healthcare services, HCA Healthcare.BenefitsMethodist ER Boerne, offers a total rewards...
-
Freestanding Emergency Room Registered Nurse
1 month ago
Boerne, Texas, United States HCA Healthcare Full timeDescription IntroductionDo you have the career opportunities as a(an) Freestanding Emergency Room Registered Nurse you want with your current employer? We have an exciting opportunity for you to join Methodist ER Boerne which is part of the nations leading provider of healthcare services, HCA Healthcare.BenefitsMethodist ER Boerne, offers a total rewards...
-
Freestanding Emergency Room Registered Nurse
1 week ago
Boerne, United States Methodist ER Boerne Full time**Introduction**: Do you have the career opportunities as a(an) Freestanding Emergency Room Registered Nurse you want with your current employer? We have an exciting opportunity for you to join Methodist ER Boerne which is part of the nation's leading provider of healthcare services, HCA Healthcare. **Benefits**: Methodist ER Boerne, offers a total rewards...
-
Acute Dialysis Registered Nurse
24 hours ago
Boerne, United States Core Dialysis Full timeCore Dialysis is a premiere organization that provides high quality acute dialysis services while simultaneously supporting efforts to maximize access and manage cost. Homegrown in Houston, Texas, this company distinguishes itself from competitors with clinical expertise throughout company ranks, exemplary professionalism, and unparalleled client...
-
Boerne, United States UnitedHealth Group Full timeOpportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you...
-
Boerne, United States UnitedHealth Group Full timeOpportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you...
-
Boerne, United States NOW Healthcare Recruiting (NP Now) Full timeBig Texas non-profit health system seeks an Endocrinologist to work in San Antonio, TX! Join 800 Physicians! - Seeking a skilled and compassionate Endocrinologist to join our team in San Antonio, Texas. With an estimated 220,000 diabetics in the community and a shortage of Endocrinologists, the demand for specialized care is high. This physician will play...
-
Rheumatologist - outpatient, 3 person team
1 week ago
Boerne, United States NOW Healthcare Recruiting (NP Now) Full timeTransparent and family feel FQHC -federally qualified health center seeks a Rheumatologist in San Antonio, Texas - 87% retention rates for our providers Rheumatologist Benefits: Great base salary! plus RVU potential! Team members enjoy Annual Team Day, Annual Gala and the San Antonio Corporate Cup Covered malpractice through Federal Tort Claim Act ...
-
Nurse Practitioner
3 days ago
Boerne, United States Vivo HealthStaff Full timeJob DescriptionJob DescriptionVivo HealthStaff is recruiting Nurse Practitioners for a practice in San Antonio, Texas providing medical examination services for Veterans.Job Details:Conduct Disability Examinations for VeteransFlexible ScheduleMalpractice ProvidedRequirements:Texas Nurse Practitioner LicenseVivo HealthStaff is a healthcare staffing and...
-
Nurse Practitioner
2 months ago
Boerne, United States Vivo HealthStaff Full timeJob DescriptionJob DescriptionVivo HealthStaff is recruiting Nurse Practitioners for a practice in San Antonio, Texas providing medical examination services for Veterans.Job Details:Conduct Disability Examinations for VeteransFlexible ScheduleMalpractice ProvidedRequirements:Texas Nurse Practitioner LicenseVivo HealthStaff is a healthcare staffing and...
-
RN/LVN Pediatric Home Health Nurse
4 weeks ago
Boerne, United States Children's Home Healthcare Full time*THIS JOB REQUIRES AN RN/LVN LICENSE, NON-LICENSED INDIVIDUALS WILL BE REJECTED*Sign-on Bonus up to $1500* *Sign-on bonus is case specific and offered based on hours worked, speak to your recruiter for more information.We currently have patients and openings in:San Antonio, Boerne, Macdona, Rio Medina, Hondo, Bulverde, Canyon Lake, Castroville, Kyle, Buda,...
