RN Case Manager PHM Telecommute Florida

Company: UnitedHealth Group
Location: New York
Posted on: November 17, 2023

Job Description:

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.------ -

The -Nurse Case -Manager -II (NCM) -is responsible for patient -case management for longitudinal -engagement, -coordination for discharge planning, transition of -care -needs -and outpatient patient management through the -care -continuum. Nurse Case Manager -will identify, screen, track, monitor -and -coordinate the -care of patients with multiple -co-morbidities -and/or -psychosocial needs -and develop a patients' -action plan -and/or discharge plan. They 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 Nurse Case Manager will 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 Nurse Case Manager will -coordinate, or provide -appropriate levels of -care under the direct supervision of -an RN Manager or MD. -Function is responsible for -clinical operations -and medical management -activities -across the -continuum of -care (assessing, planning, implementing, -coordinating, monitoring -and -evaluating). This includes -case management, -coordination of -care, -and medical management -consulting. -Function may -also be responsible for providing health -education, -coaching -and treatment -decision support for patients. The Nurse Case Manager will -act -as -an -advocate for patients -and their -families -guide them through the health -care -system for transition -planning -and -longitudinal -care. The Nurse Case Manager will work in partnership with an -assigned Care Advocate -and -Social -Worker.

Primary Responsibilities:

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• Engage patient, -family, -and -caregivers telephonically to assure that a well-coordinated -action plan is -established -and -continually -assess -health status
  
• Provide member -education to assist with self-management -goals; disease -management or -acute -condition and provide indicated -contingency plan
  
• Identify patient needs, -close health -care gaps, develop action plan -and prioritize -goals
  
• Utilizing -evidenced-based practice, -develop -interventions while -considering member barriers independently
  
• Provide patients with -"welcome home" -calls to ensure that discharged patients' -receive the necessary services -and resources -according to -transition plan
  
• Conducts a transition discharge -assessment onsite -and/or telephonically to identify member needs -at -time of transition -to a lower level of -care
  
• Independently serves -as -the -clinical -liaison with hospital, clinical and -administrative staff -as -well -as performs a review for -clinical authorizations for inpatient -care utilizing -evidenced-based -criteria within our documentation -system for discharge planning -and/or next site of -care needs
  
• In -partnership with -care -team -triad, -make referrals -to -community sources -and programs identified for patients
  
• Utilize motivational interviewing techniques to understand -cause -and -effect, -gather or review health history for -clinical -symptoms, -and -determine health literacy
  
• Manages -assessments regarding -patient -treatment plans -and -establish -collaborative relationships with physician -advisors, -clients, patients, and providers
  
• Collaborates -effectively with -Interdisciplinary Care Team -(IDCT) to establish -an individualized transition plan -and/or -action plan -for patients
  
• Independently -confers with UM Medical Directors -and/ or Market Medical Directors on a regular -basis regarding inpatient cases -and participates in departmental huddles
  
• Demonstrate knowledge of utilization management processes -and -current standards of -care -as a foundation for utilization review -and -transition planning -activities
  
• Maintain -in-depth knowledge of -all -company products and services -as -well -as -customer issues -and needs through ongoing training -and -self-directed research
  
• Manage -assigned -caseload in an -efficient and -effective manner utilizing time management skills
  
• Enters timely -and -accurate documentation into designated -care management -applications to comply with documentation requirements -and -achieve -audit scores of 95% or better on a monthly basis
  
• Maintain current -licensure to work in state of -employment -and -maintain hospital -credentialing -as indicated
  
• Performs -all other -related 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:
  
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  • Associate's degree in Nursing
    
  • Current, unrestricted RN license, specific to -the state of -employment or a compact nursing license
    
  • Case Management -Certification (CCM) or -ability to obtain -CCM within 12 months -after the -first -year -of -employment
    
  • 3+ -years of diverse -clinical experience; preferred in -caring for the -acutely ill patients with -multiple disease -conditions
    
  • 3+ -years of -managed -care -and/or -case management -experience
    
  • Knowledge of utilization management, quality improvement, and discharge planning
    
    
    Preferred Qualifications:
    
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    • Experience working with psychiatric -and geriatric patient populations
      
    • Knowledgeable in Microsoft Office -applications including Outlook, -Word, -and Excel Ability to -read, -analyze -and interpret -information -in medical records, -and -health plan documents
      
    • Bilingual (English/Spanish) OR (English/Vietnamese) - -language proficiency
      
    • Demonstrated ability to problem solve -and identify -community -resources
      
    • Demonstrated ability to prioritize, plan, -and handle multiple tasks/demands simultaneously
      
    • Proven planning, organizing, -conflict resolution, negotiating -and interpersonal skills
      
    • Proven independently utilizes -critical thinking skills, nursing judgement -and decision-making skills
      
      
      *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
      
      At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
      
      
      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.

Keywords: UnitedHealth Group, New York , RN Case Manager PHM Telecommute Florida, Healthcare , New York, New York