LVN Case Manager Telecommute in Houston TX
Company: UnitedHealth Group
Location: Indianapolis
Posted on: June 25, 2022
Job Description:
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 Nurse Case Manager I (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.
The Nurse Care Manager will determine medical appropriateness of
outpatient services following evaluation of medical guidelines and
benefit determination. The Nurse Case Manager will coordinate, or
provide appropriate levels of care under the direct supervision of
an RN 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. This role acts as a support to team members,
coaching, guiding and providing feedback as necessary. 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. If
you are located in Houston, TX, you will have the flexibility to
telecommute* as you take on some tough challenges. Must be based in
Houston area and able to come into the office when needed. Primary
Responsibilities:
- 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
- With oversight of RN and/or MD, utilizing evidence-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
- 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:
- High School Diploma/GED
- Current, unrestricted Texas or Compast State LPN/LVN license
-
- 2+ years of managed care and/or case management experience
- 2+ years of clinical experience
- Knowledge of managed care, medical terminology, referral
process, claims and ICD-10 codes
- Full COVID-19 vaccination is an essential job function of this
role. Candidates located in states that mandate COVID-19 booster
doses must also comply with those state requirements. UnitedHealth
Group will adhere to all federal, state and local regulations as
well as all client requirements and will obtain necessary proof of
vaccination, and boosters when applicable, prior to employment to
ensure compliance. Candidates must be able to perform all essential
job functions with or without reasonable accommodation Preferred
Qualifications:
- Case Management certification -
- Knowledge of utilization management and/or insurance review
processes as well as current standards of care, a solid knowledge
of health care delivery systems and the ability to interact with
medical directors, physician advisors, clinicians and support
staff
- Proficient computer skills in Microsoft applications and
Microsoft Excel
- Skills in planning, organizing, conflict resolution,
negotiation and interpersonal skills to work with autonomy in
meeting case management goals and initiatives
- The ability to work independently in accomplishing assignments,
program goals and objectives
- Excellent verbal and written skills Physical & Mental
Requirements: -
- Ability to lift up to 10 pounds
- Ability to push or pull heavy objects using up to 25 pounds of
force
- Ability to sit for extended periods of time
- Ability to stand for extended periods of time
- Ability to use fine motor skills to operate office equipment
and/or machinery
- Ability to properly drive and operate a company vehicle
- Ability to receive and comprehend instructions verbally and/or
in writing
- Ability to use logical reasoning for simple and complex problem
solving To protect the health and safety of our workforce, patients
and communities we serve, UnitedHealth Group and its affiliate
companies require all employees to disclose COVID-19 vaccination
status prior to beginning employment. In addition, some roles and
locations require full COVID-19 vaccination, including boosters, as
an essential job function. UnitedHealth Group adheres to all
federal, state and local COVID-19 vaccination regulations as well
as all client COVID-19 vaccination requirements and will obtain the
necessary information from candidates prior to employment to ensure
compliance. Candidates must be able to perform all essential job
functions with or without reasonable accommodation. Failure to meet
the vaccination requirement may result in rescission of an
employment offer or termination of employment. 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) 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. 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, Indianapolis , LVN Case Manager Telecommute in Houston TX, Executive , Indianapolis, Indiana
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