Telephonic RN Case Manager Telecommute Texas or Florida

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm)

WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

The Case Manager is a participant in the collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs. This process includes medical, social, developmental, behavioral, financial, and educational intervention with focus on quality and cost effective outcomes.

Hours will be in between 7am and 5pm Monday - Friday. No nights, weekends or on-call.

If you are located in Texas or Florida, you will have the flexibility to telecommute as you take on some tough challenges.

Only considering candidates located in TX and FL

Primary Responsibilities:

• Engage and provide care management to commercial patient populations identified from the Health Plan, clinical meetings, outlier reports, plan specific insights, and predictive modeling
• Complete Transition of Care follow up and assessment post discharge
• Provide care management telephonically
• Complete required assessments
• Create a personalized care plan for each patient involved in care management to resolve barriers to care, close quality gaps in care, build additional education or contingency planning and engage with social support systems as appropriate
• Regularly interact with health plan clinical programs and clinical personnel for care coordination
• Complete all necessary care coordination and or assessment activities as outlined in the care plan
• At least monthly or as needed, attend telephonic patient care conferences/meetings with the clinic or health plan on assigned patients involved in care management
• Weekly and as needed, participate in internal JOC meetings for plan specific insights, best practices and intervention development
• Follow NCQA Care Management, Person Centered Medical Home and Accountable Care Organization accreditation standards
• Document all patient care activities into electronic database
• Meet required Key Performance Indicators
• Pass Quality Audit metrics
• Coordinate and cooperate with other members of the care management team
• Support team through onboarding and training of new hire members
• Perform other duties as assigned
  

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:

• ADN, ASN or BSN
• Current Unrestricted RN Texas , Florida Or Compact State Licensure
• Case Management Certification or completion of CCM Certification within 1 year of employment
• 3+ years of post-licensure care management experience
• Experience in completion of assessment, care plans, care coordination and issue resolution
• Electronic case management and medical record experience
• Patient engagement experience including strong telephonic motivational interviewing skills
• Knowledge of healthcare reimbursement, Utilization Management, discharge planning, Disease Management
• Intermediate knowledge of Commercial Plans, applicable state Department of Insurance regulations and health plans
• Knowledge of NCQA standards in Primary Care Medical Home and Care Management, as well as Accountable Care Organization
• Demonstrated ability to work remotely

Preferred Qualification:

• Bi-lngual English/ Spanish
• Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking
• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi - specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.