12 days old

Registered Nurse RN Outpatient Case Manager Healthcare WellMed San Antonio TX

San Antonio, TX 78205
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  • Job Code
    870510

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.


Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)


The primary responsibility of the Case Manager is to identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a case management care plan. They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers,  educators, health care coordinators/managers. The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence. The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions. The Case Manager may perform telephonic and/or face-to-face assessments.


Job Responsibilities:

  • In consultation with manager of Care Management, conducts initial assessments within designated time frames for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
  • In consultation with manager of Care Management collaborates effectively with IDT to establish an individualized care plan for members with interventions to assist the member in meeting short and long term goals
  • Engage patient, family, and caregivers to assure that a well-coordinated care plan is established.
  • Will identify member needs, develop care plan and prioritize goals; using evidence based practice the Case Manager will develop interventions while considering member barriers with guidance from medical directors and Manager of Care Management
  • Make outbound calls to assess member health status, identify gaps or barriers in care plan
  • Provide member education to assist with self-management goals
  • Make referrals to outside sources
  • Educate members on disease process or acute condition and provide indicated contingency plan with guidance from medical directors and Manager of Care Management
  • Coordinates visits with PCP and specialists on a limited basis, performs visual assessment for skin checks on exposed skin, and conducts home safety evaluation
  • Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a monthly basis
  • Adheres to organizational and departmental policies and procedures
    • Takes on-call assignment as directed
  • The Case Manager will also maintain current licensure to work in state of employment. Decision making is based on regulatory requirements, policies and procedures, and current clinical guidelines
    • Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
  • Monitors for quality concerns regarding member care and reports as per policy and procedure.
  • Performs all other related duties as assigned

 Full-Time Field Base Position: This position requires 100% traveling around the San Antonio, TX and counties areas supporting WellMed Patients. Must have reliable transportation and available to work flexible shifts. Rotating on-calls required.


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: 2020-03-21 Expires: 2020-04-21

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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Registered Nurse RN Outpatient Case Manager Healthcare WellMed San Antonio TX

UnitedHealth Group
San Antonio, TX 78205

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