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UnitedHealth Group RN Case Manager USMD Irving in Arlington, Texas

USMD part of OptumCare is a multi - specialty group of hospital, clinics and physicians. USMD serves the Dallas - Fort Worth metropolitan area with more than 250 physicians and associate practitioners, and provides healthcare services to patients in more than 20 different specialties at its 2 hospitals, 4 cancer treatment centers and nearly 50 physician clinics, many of which are multi - specialty.

The Case Manager is a participant in the collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs. This process includes medical, social, developmental, behavioral, financial, and educational intervention with focus on quality and cost effective outcomes.

Primary Responsibilities:

  • Engage and provide care management to identified patient populations

  • Provide care management telephonically or face to face in the clinical practice setting

  • Travel to additional clinics to facilitate face to face care management as indicated

  • Complete required assessments

  • Create a personalized care plan for each patient involved in care management to resolve barriers to care, build additional education or contingency planning and engage with social support systems as appropriate

  • Coordinate with health plan clinical programs as appropriate

  • Complete all necessary care coordination and or assessment activities as outlined in the care plan

  • Attend clinical round meetings on assigned patients involved in care management

  • Follow NCQA Care Management accreditation standards

  • Document all patient care activities into electronic database

  • Meet required Key Performance Indicators

  • Pass Quality Audit metrics

  • Perform other duties as assigned

  • Coordinate and cooperate with other members of the care management team

Required Qualifications:

  • Current independent and unrestricted Texas RN licensure

  • 1 year of post-licensure care management experience

  • Experience in completion of assessment, care plans, care coordination and issue resolution

  • Electronic case management and medical record experience

  • Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking

  • Knowledge of healthcare reimbursement , Utilization Management, discharge planning, Disease Management

  • Basic knowledge of Medicare, Medicare Advantage Plans, Commercial Plans, Texas Department of Insurance regulations and health plans

  • Knowledge of NCQA standards in Primary Care Medical Home and Care Management, as well as Accountable Care Organization

  • Verbal and writing ability to communicate effectively in informing employees of activities and policies

  • Numerical ability

Preferred Qualifications:

  • Case Management Certification or completion of CCM Certification within 1 year of employment

  • Ability to receive, comprehend, and carry out instructions

  • Ability to work safely with equipment, supplies, and materials

  • Ability to comply with attendance requirements

  • Ability to comply with Human Resource policies

  • Motivational Interviewing experience

Physical Demands & Working Conditions:

Mostly sedentary, lifts up to 10 lbs., walks, stands may climb stairs. Ability to travel to more than one clinic as needed for business purposes.

Careers with USMD. If you’re idea of a great day at work involves putting great new ideas to work, we should talk. Throughout the greater Dallas area, we’ve built an evolving, integrated health care model that brings primary care and specialist providers together to work in new and better ways. A thriving part of OptumCare and the UnitedHealth Group family of companies, our multi-specialty group of hospitals, clinics and providers features more than 250 physicians and associate practitioners. We provide health care services to patients in more than 20 different specialties at our two hospitals, four cancer treatment centers and nearly 50 physician clinics. Join us and start doing your life’s best work.(sm)

Diversity creates a healthier atmosphere: OptumCare and its affiliated medical practices are 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 and its affiliated medical practices is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: RN, Case Manager, Clinic, USMD, Texas, TX