29 days old

Inpatient RN Case Manager - Harlingen, TX - 925462

Harlingen, TX 78550
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  • Job Code
    925462

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 lifes best work.(sm)

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The Inpatient RN Case Manager 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. Participates in integrated care team conferences to review clinical assessments, update care plans, identify members at risk for readmission and to finalize discharge plans.

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Primary Responsibilities:

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  • Collaborates effectively with integrated care team (ICT) to establish an individualized plan of care for members; the interdisciplinary care team develops interventions to assist the member in meeting short- and long-term plan of care goals
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  • Serves as the clinical liaison with hospital, clinical and administrative staff as well as provides expertise for clinical authorizations for inpatient care. based on utilized evidenced-based criteria
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  • Performs concurrent and retrospective onsite or telephonic clinical reviews at the designated network or out of network facilities; documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines
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  • Interacts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs and formulate discharge plan and provide health plan benefit information
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  • Stratifies and/or validates patient level of risk and communicates during transition process with the Integrated Care Team
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  • Provide assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or members home; develops interventions and processes to assist the member in meeting short- and long-term plan of care goals
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  • Manages assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process directly monitoring assigned members
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  • Demonstrates knowledge of utilization management and care coordination processes and current standards of care as a foundation for transition planning activities
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  • Confers with physician advisors on a regular basis regarding inpatient cases and participates in department case rounds. Plans member transitions, with providers, patient and family
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  • Problem solving by gathering and /or reviewing facts and selecting the best solution from identified alternatives; decision-making is usually based on prior practice or policy, with some interpretation; must apply individual reasoning to the solution of problems, devising or modifying processes and writing procedures as necessary
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  • Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
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  • Refers cases to Medical Director as appropriate for review or requests not meeting criteria or for complex case situations
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  • Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
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Youll 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.

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Required Qualifications:

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  • Education:"""
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    • Bachelors degree in Nursing, or
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    • Associates degree in Nursing and Bachelors degree in related field, or
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    • Associates degree in Nursing combined with 4 or more years of experience
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  • Current, unrestricted Texas RN license or compact license
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  • Case Management Certification (CCM) or ability to obtain CCM within one year of employment
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  • 5+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
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  • 2+ years of managed care and/or case management experience
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  • Knowledge of utilization management, quality improvement, discharge planning, and cost management
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  • Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area
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  • Proficient with Microsoft Office applications including Word, Excel, and Power Point
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  • Ability to stand, walk or sit for prolonged periods
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  • Ability to read, analyze and interpret information in medical records, health plan documents and financial reports
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  • 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
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  • You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • Experience working with psychiatric and geriatric patient populations
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  • Bilingual (English/Spanish) language proficiency
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  • Ability to solve practical problems and deal with a variety of variables
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  • Ability to prioritize, plan, and handle multiple tasks/demands simultaneously
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  • Planning, organizing, conflict resolution, negotiating and interpersonal skills
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  • Independent problem identification/resolution and decision-making skills
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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)

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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.

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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.

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UnitedHealth Group is a drugfree workplace. Candidates are required to pass a drug test before beginning employment.

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"Job Keywords: Inpatient RN Case Manager, Registered Nurse, RN, Inpatient Care Manager, Healthcare, WellMed, Managed Care, Rio Grande Valley, McAllen, Harliingen, Texas, TX
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Posted: 2021-05-18 Expires: 2021-07-16

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Inpatient RN Case Manager - Harlingen, TX - 925462

UnitedHealth Group
Harlingen, TX 78550

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