Registered Nurse Case Manager Specialized Clinical Programs WellMed San Antonio TX

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.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:

Current, unrestricted RN license, specific to the state of employment including ability to obtain additional state licenses as directed

5+ years of managed care and/or care management experience

5+ years of clinical experience

Knowledge of managed care, medical terminology

Excellent verbal and written skills

Proficiency in Microsoft Office products including Access, Excel, Word, PowerPoint and Outlook

Skills in planning, organizing, conflict resolution, negotiation, critical thinking and interpersonal skills to work with autonomy

Experience with CMS and NCQA requirements for Special Needs Programs

Proficient experience in Medicare and Medicaid population

The ability to work independently in accomplishing assignments, program goals and objectives

Experience carrying caseload of members

Preferred Qualifications:

10+ years of clinical experience

5+ years of case management experience - telephonic and/or face-to-face

Certified Case Manager (CCM)

Physical & Mental Requirements:

Ability to lift up to 10 pounds

Ability to push or pull heavy objects using up to 10 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 receive and comprehend instructions verbally and/or in writing

Ability to use logical reasoning for simple and complex problem solving

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 350,000+ 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.OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.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.Job Keywords: WellMed, Healthcare, Bilingual, Registered Nurse, Case Manager, Specialized Clinical Programs, Telephonic Special Needs Population, CMS, NCQA, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Texas, TX