10 days old

Licensed Vocational Nurse LVN/LPN Care Manager WellMed San Antonio TX

San Antonio, TX 78205
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  • Job Code
    875464

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)


 

The Telephonic Care Manager (TCM) is responsible for utilization management and inpatient care management coordination in a telephonic care management position. The Care Manager will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. The Care Manager works under the direct supervision of an RN or MD. This role acts as a support to team members, coaching, guiding and providing feedback as necessary. This function is responsible for care management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). The Telephonic Care Manager (TCM), LVN will act as an advocate for members and their families guide them through the Health Care system for transition planning. The function may also be responsible for providing health education, coaching and treatment decision support for members and will participate in interdisciplinary care conferences.
 
Primary Responsibilities:

  • The TCM serves as the telephonic clinical liaison with hospital clinical and administrative staff as well as providing expertise for clinical authorizations for inpatient care
  • Makes outbound calls to assess members' current health status
  • Performs case reviews telephonically for assigned inpatient facilities and skilled nursing facilities. Advises supervisor of any potential problems as they become evident
  • Ensures that our members receive the proper levels of care based on evidence-based criteria and assesses and interprets needs and requirements, in addition to referring patients to disease or case management programs. Makes "welcome home" calls to ensure that discharged member receive the necessary services and resources according to transition plan
  • Conduct Utilization Reviews (concurrent and retrospective reviews) using approved health plan guidelines such as Milliman Criteria and/or InterQual Criteria
  • Demonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning activities
  • Track ongoing status of all certification activity and maintain continuing certification (or denial)
  • Makes telephonic assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers
  • Adhere to quality standards and state UR guidelines, as well as confidentiality of all information, policies, and procedures. Adheres to company policies, procedures, and reporting requirements
  • Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
  • Performs all other related duties as assigned
  • Identify and refer all potential quality issues to the Clinical Quality Management Department, and suspected fraud and abuse cases to Compliance Department

This is an office-based position, Oaks III, 78249 / Office park located at IH 10 East and De Zavala Road.

   

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.

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Posted: 2020-05-16 Expires: 2020-06-15

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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Licensed Vocational Nurse LVN/LPN Care Manager WellMed San Antonio TX

UnitedHealth Group
San Antonio, TX 78205

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