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.
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
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
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
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