WellMed Outpatient RN Case Manager

Profile

**THIS IS A HYBRID POSITION.  YOU WILL WORK IN THE OFFICE/HOME AND MAKE PATIENT VISITS.**
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)
The primary responsibility of the Outpatient Case Manager is to identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a case management plan of care. They will interact and collaborate with interdisciplinary care team, which includes physicians, transition care managers (i.e., UM inpatient case managers), referral coordinators, pharmacists, social workers, and other educators and nurses. The OP CM also acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence. The OP CM will participate in integrated care team conferences to review clinical assessments, update care plans and determine follow-up frequency with the team. The OP Case Manager performs telephonic and face to face assessments.
Primary Responsibilities:
The Outpatient Case Manager conducts initial assessments within designated timeframes on patients identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
Collaborates effectively with integrated care team to establish an individualized plan of care for members
The integrated care team includes physicians, case managers, referral coordinators, pharmacists, social workers, and other disease educators
Develops interventions to assist the member in meeting short and long term plan of care goals
Engage patient, family, and caregivers to assure that a well-coordinated treatment plan is established
Prioritize care needs, set goals and develop an initial plan of care that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation
Make outbound calls to assess member health status, identify gaps or barriers in treatment plans
Provide member education to assist with self- management goals
Make referrals to outside sources
Educate members on disease process or acute condition
Coordinates and attends member visits with PCP and specialists as needed in special circumstances
On a limited bases, a physical assessment may include taking of blood pressure, heart rate, respiratory assessment: Rate, effort, pulse oximetry, peripheral circulation and skin checks on exposed skin, foot checks for edema and skin integrity, home safety evaluation
Seeks ways to improve job efficiency and makes appropriate suggestions following the appropriate chain of command
Performs all duties for internal and external customers in a professional and responsible manner having fewer than two complaints per year
Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a quarterly basis
Adheres to organizational and departmental policies and procedures
Takes on-call assignment as directed
Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
With the assistance of the Managed Care/UM teams, guides physicians in their awareness of preferred contracts and providers and facilities
Attends educational offering to keep abreast of change and comply with licensing requirements and assists in the growth and development of associates by sharing knowledge with others
Participates in the development of appropriate QI processes, establishing and monitoring indicators
Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations 
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:
Bachelor’s degree in Nursing or Associate’s degree in Nursing and Bachelor’s degree in related field or Associate’s degree in Nursing combined with 4 years of experience
Current unrestricted Texas RN license or compact license
Case Management Certification (CCM) or ability to obtain CCM within 1 year of employment
5 years of diverse clinical experience with experience in caring for the acutely ill patients with multiple disease conditions
3 years of case management experience
Knowledge of utilization management, quality improvement, discharge planning, and cost management  
Proficient with Microsoft Office applications including Word, Excel, and Power Point 
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 disease
Full COVID-19 vaccination is an essential requirement of this role. **MEMBERS ONLY**SIGN UP NOW***. will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance 
Preferred Qualifications:
Certified Diabetes Educator, or Certified Case Manager
Experience working with psychiatric and geriatric patient populations
Bilingual (English/Spanish) language proficiency
To protect the health and safety of our workforce, patients and communities we serve, **MEMBERS ONLY**SIGN UP NOW***. and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. **MEMBERS ONLY**SIGN UP NOW***. 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 employment.
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 550,000 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 **MEMBERS ONLY**SIGN UP NOW***. 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: **MEMBERS ONLY**SIGN UP NOW***. 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.
**MEMBERS ONLY**SIGN UP NOW***. is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. 
Job Keywords: RN, Registered Nurse, Care Manager, Case Manager, Case Management, CCM, Home Care, Home Health, UHG, WellMed, Medicare, McAllen, Texas, TX, Outpatient
Job Requirements
Job Snapshot
Location
US-TX-McAllen
Employment Type
Full-Time
Pay Type
Year
Pay Rate
N/A
Store Type
Health Care

Company info

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