1+ months

Registered Nurse RN Specialized Clinical Programs / Case Manager Healthcare WellMed - San Antonio TX

San Antonio, TX 78205
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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 Specialized Clinical Programs (SCP) Case Manager may perform telephonic and/or face-to-face assessments including ongoing re-assessment, case planning, service coordination and monitoring of the services that eligible members with special needs receive. Collaborates with the member and other health care providers to facilitate member access to health and social services, foster adherence to efficient and cost-effective medical treatment regimens which enhance member's health and well-being. Facilitates a proactive partnership with members to enhance and personalize management of health-related needs. Conducts comprehensive assessment of needs, continuous care plan development, coordination and evaluation of member's services leading to the goal of equipping and empowering members and caregivers to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting. Also responsible for providing health education, coaching and treatment decision support for members. Participates in Interdisciplinary Team conferences (IDT) to review care plan and member progress on identified goals and interventions. The SCP Case Manager will work in partnership with an assigned Care Navigator.

Primary Responsibilities:

  • Ability to assess a complex population and interpret member needs and requirement
  • Perform individual health risk questionnaires assists with individualized care plan design, documentation and implementation of care plan activity, transitions of care coordination, and evaluation of outcomes
  • Perform initial review of member's health records and current health status (e.g., health risk scores) to identify health risk and determine next steps
  • Perform medication reconciliation
  • Receive information from members about specific symptoms and answer questions
  • Identifies the targeted high-risk population, and perform risk stratification
  • Evaluate member data throughout the assessment process to identify inconsistencies and adherence to Evidence Based Guidelines
  • Work to develop identified individualized interventions for members in care management
  • Utilize Motivational Interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
  • Utilizes critical thinking skills to solve complex problems and/or conduct complex analyses
  • Identify and prioritize gaps to develop plan of care to empower members to meet identified goals
  • Collaborate with members to set their own goals and align care activities with those goals
  • Monitor progress of goals, adjust care needs accordingly
  • Provide treatment recommendations and ongoing monitoring and evaluation of members
  • Make follow-up calls to ensure members receive the necessary services, resources and care plan created with their nurse
  • Assure appropriate and complete data entry of all documentation per guidelines
  • Establish effective collaboration, communication and coordination among all responsible parties of a member's multidisciplinary health care team
  • Collaborate with member's primary care physician and other providers/specialists of any potential problems as they become evident.
  • Ensure members receive the proper level of care via coordination, assessment and interpretation of needs and requirements. Provide specific disease self-management education to members face-to-face and telephonically
  • Coaches, provides education on disease processes, obtain feedback, and guide members on interventions to improve health outcomes
  • Responsible for meeting CMS, NCQA, and all other regulatory compliance requirements for CMS Special Needs Program (SNP) Model of Care
  • Adheres to quality standards, HIPAA, confidentiality, company policies, procedures and reporting requirements
  • Actively participates in quality assessment/performance improvement program
  • Works with minimal guidance; seeking guidance on only the most complex tasks
  • Performs all other related duties as assigned

This is an office based position located at our office off of Northwest Parkway, 78249 in San Antonio, TX - Must be willing to perform face-to-face assessments as deemed necessary.



Jobs Rated Reports for Registered Nurse

Posted: 2019-07-31 Expires: 2019-09-30

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 Specialized Clinical Programs / Case Manager Healthcare WellMed - San Antonio TX

UnitedHealth Group
San Antonio, TX 78205

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Registered Nurse
118th2018 - Registered Nurse
Overall Rating: 118/220
Median Salary: $70,000

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