Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Please note: This is an office based position located at our office off of Northwest Parkway in San Antonio, TX. The Telephonic Special Needs Population (SNP) Case Manager is responsible for transitions of care and SNP compliance in a telephonic case management role. This role is solely telephonic based. The SNP Case Manager will review Transition Discharge assessments (TDAs) and/or perform Health Plan approved Health Risk assessments (HRA) to determine member needs and develop a Care Plan for all identified health diagnoses. The SNP Case Manager also identified social needs and refers to social services as needed. This position will require critical thinking and management of all SNP transitions including moderately complex problems and / or moderately complex analyses, and identify solutions. The SNP case manager is responsible for medical management activities across the transitions of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes SNP management, referral to Disease / Care management, and coordination of care. The function may also be responsible for providing health education, coaching and treatment decision support for members and will work closely with Interdisciplinary teams in the ongoing development and implementation of coordination of care processes. Primary Responsibilities: The SNP Case Manager serves as the telephonic SNP Performance RN managing all member transitions for a period of up to 90 days following transitions, Makes outbound calls to assess members' current health status every 3 months and updates care plan accordingly and communicates with member and / or caregiver and pcp Performs HRA and develops detailed care plan for all member diagnosis identified following a transition and collaborates with member's primary care physician of any potential problems as they become evident Ensures that our members receive the proper levels of care, coordinating their care, and assesses and interprets needs and requirements, in addition to referring patients to disease or care management programs Makes transition discharge follow up calls to ensure that discharged member receive the necessary services and resources and care plan up to date Demonstrate knowledge of SNP compliance and health plan delegation expectations Track ongoing status of all transitions for all health plans and enterprise key milestones Adhere to quality standards, as well as confidentiality of all information, policies, and procedures. Adheres to company policies, procedures, and reporting requirements Maintain in-depth knowledge of all Well - med programs and services as well as managing members' issues and needs through the transition period Performs all other related duties as assigned
Required Qualifications: Education required: Bachelor's degree in Nursing, or Associate's degree in Nursing combined with 2 or more years of experienceCurrent, unrestricted RN license required, specific to the state of employment 2 years of managed care and/or care management experience 3 years of clinical experience Knowledge of managed care, medical terminology, Excellent verbal and written skills Skills in planning, organizing, conflict resolution, negotiation and interpersonal skills to work with autonomy in meeting SNP compliance The ability to work independently in accomplishing assignments, program goals and objectives This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of diseasePreferred Qualifications: Knowledge of SNP requirements 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 90,000+ 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) Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.UnitedHealth Group 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, Telephonic Special Needs Population, SNP Performance, Disease/Care management, San Antonio, New Braunfels, Seguin, Gonzales, Shiner, Yoakum, Boerne, Floresville, Helotes, Texas, TX
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.