RN Case Manager, Inpatient Services - Remote From West Texas

Rn Case Manager

WellMed, part of the Optum family of businesses, is seeking a RN Case Manager to join our team. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Position Highlights & 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.

+ 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.

Required Qualifications:

+ Associate's degree in Nursing.

+ Current, unrestricted RN license required, specific to the state of employment.

+ Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment.

+ 3+ years of diverse clinical experience as an RN caring for the acutely ill patients with multiple disease conditions in a hospital setting.

+ 1+ years of case management, managed care or utilization management experience.

+ Proven knowledge of utilization management, quality improvement, and discharge planning.

+ Access to reliable transportation and maintain an active driver's license.

Preferred Qualifications:

+ Experience working with psychiatric and geriatric patient populations.

+ Proven knowledge in Microsoft Office applications including Outlook, Word, and Excel.

+ Bilingual (English/Spanish) language proficiency.

+ Proven ability to read, analyze and interpret information in medical records, and health plan documents.

+ Proven ability to problem solve and identify community resources.

+ Proven ability to possess planning, organizing, conflict resolution, negotiating and interpersonal skills.

+ Proven to independently utilizes critical thinking skills, nursing judgement and decision-making skills.

+ Ability to prioritize, plan, and handle multiple tasks/demands simultaneously.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.