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Nurse Case Manager - Remote in Houston, TX

Company: UnitedHealth Group
Location: Sugar Land
Posted on: November 23, 2022

Job Description:

Careers at Landmark, part of the Optum and UnitedHealth Group family of businesses. At Landmark, we work to deliver high quality, comprehensive care to chronically ill patients wherever they reside and whenever they need it. We focus on doing what's right for the people we serve, even when it's not easy. This is your opportunity to be part of a compassionate team that is setting out to change health care for complex, chronic patients. We're looking for driven people like you because changing the status quo takes dedication. Here, we'll invest in your personal and professional growth while giving you a unique opportunity to make a difference. Helping people feel their best is a rewarding part of doing your life's best work.(sm)The Nurse Care Manager (NCM), is an integral part of the Interdisciplinary care team (IDT), and is responsible for the overall care management process for high acuity esngaged patients. The NCM has oversight for developing, managing, and coordinating patients' plan of care to include medical and psychosocial needs and patient-centered goals. The NCM works with patients/caregivers to maintain and improve health status by providing care coordination, health education, guidance and support for medical and psychosocial complex chronic conditions. Professionals in this role elicit input from the IDT based on initial and ongoing comprehensive assessments of the patient. The NCM uses nursing assessment, evaluation skills, data and reports to guide care planning decisions for the patient. They are skilled at navigating the patients' health plan benefits to identify providers, resources and vendors that provide required care and services. The NCM works collaboratively with the IDT to provide appropriate, effective, high quality, and cost-effective care to engaged patients in their current residence. If a patient requires care outside their residence, the NCM collaborates with community-based service providers to ensure coordinated care during critical times of transition between health care settings and home. In addition to the NCM, the HbMC IDT includes but not limited to, physicians, nurse practitioners, physician assistants, nurse care managers, behavioral health clinicians, social workers, pharmacists, dietitian/nutritionists, ambassadors, care coordinators, the patient and/or caregiver and family. If you are located in Sugar Land, TX, you will have the flexibility to work remotely* as you take on some tough challenges. Telecommute must be based in a 50 mile radius from office in Sugar Land, TXPrimary Responsibilities:

Acts as an advocate for the patientEngages and collaborates with patient/caregiver and providers to develop an individualized Care Plan that addresses disease management, health promotion, and patient-centered goalsMonitors patient progress against Care Plan goals with an emphasis on patient care needs during times of transition in care setting and changes in health statusIdentifies barriers to achieving Care Plan goals and collaborates with patient/caregiver as well as IDT to overcome barriers to successUnderstands and adheres to regulatory timeframes and standards required by National Committee for Quality Assurance (NCQA) within a Delegated Case Management market and Dual & Chronic Special Needs Plans (SNP)Provides disease management, health promotion and prevention education to patients/caregivers and/or family patients to manage disease progression and encourage proper medical testing, so patient can remain as independent as possibleCompletes initial and ongoing patient assessment, using information gathered from patient/caregiver/family, providers, HbMC EMR, and available medical recordsManages and coordinates care and services within an Interdisciplinary TeamManages incoming clinical calls to ensure patients' medical concerns are addressed by the care team in a timely mannerParticipates in and documents advance directive conversations with patient/caregiver and/or family, and collaborates to reconcile patient/caregiver goals with the current clinical statusCoordinates care needs across the continuum of care and is the point of contact for patient/caregiver and cliniciansLeads daily IDT HuddleActively participates in HbMC meetings and education sessionsActs as liaison between providers, nursing facilities, hospitals and program staff, including making recommendations about care alternativesFacilitates/coordinates admission to a recommended level of care on a temporary or permanent basisPromotes patient safety. Reviews or initiates a home safety, functional assessment, and/or falls risk assessment with home-based providers to determine need for adaptive equipment. Assists with acquisition of assistive equipment, as recommendedMonitors patient during admissions and provides nursing/assisted living facility and provider training on HbMC program philosophy and approach to patient careSupports patients during transitions of care through assessment, coordination of care, education of the plan of care and evaluation of the effectiveness of the planIdentifies and reports any potential quality-of-care issues to Clinical Supervisor/HSD, so a plan of improvement can be developed and implemented, as neededAt times, the NCM may visit a patient in their home for education or assessment, Market/State dependentMaintains HIPAA complianceYou'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.To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Required Qualifications:
Associate degree or higher in Nursing (RN)Hold RN License in the State(s) where you will practice. Texas RN License must be current, active, unrestricted, and unencumberedProficient in patient-centered Care Plan creation and active management 3+ years of clinical practice in a hospital, home care, hospice, clinic, or nursing home setting Electronic Medical Record documentation experience Computer skills: internet navigation, Microsoft Office - Outlook, Word and Excel Access to reliable transportation required; if you are driving a vehicle, you must comply with all the terms of the Optum Motor Vehicle Safety policyPreferred Qualifcations:
BSN Case Management experience and CCM Certification1+ years of Utilization Management experience Disease state management experience with solid ability to educate patients on health and wellness Population Health management experience Ability to manage a patient caseload using data and reports Advanced interpersonal and telephonic communication skillsSolid organizational skillsAbility to complete all work independently and within designated timeframesAdaptable, flexible, and able to maintain a positive attitude during change in process, practice, or policyFull COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodationTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employmentCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyDiversity 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.

Keywords: UnitedHealth Group, Sugar Land , Nurse Case Manager - Remote in Houston, TX, Healthcare , Sugar Land, Texas

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