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) The RN Case Manager is responsible for carrying out day-to-day support duties and facilitating teaching related to the Chronic Care, Congestive Heart Failure, Ischemic Heart Disease, COPD / Asthma and Diabetes Programs. The RN Case Manager works in conjunction with the Disease Management team, physician advisors to the program, clinic staff and primary care physicians. This position assists in providing patient empowerment through the use of motivational interviewing skills, problem solving and self-management goal setting. Primary Responsibilities:Works with the PCP and clinic staff to identify patients with high risk diagnoses such as CHF, IHD, COPD / Asthma and Diabetes and ensures clinical guidelines are being followed Conducts Chronic Care Model visits and reviews the patient's informal and formal support systems, focusing on what patients want to improve and educating them about their chronic disease Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete self-management goal / action plans Enters timely and accurate data into the Disease Management Database, PsiMed, SmartClinic and other applications necessary to communicate patient needs and to ensure complete documentation of patient visits and phone calls Pulls tasking report from disease management database and conducts Chronic Care Model follow-up phone calls to eligible CCM enrolled members who have set self-management support goals within 2 weeks of date tasked Ensures all delegated tasks are also completed within 2 weeks of date tasked Tracks self-management goal outcomes and documents in disease management database Maintains current knowledge regarding CHF, IHD, COPD / Asthma and Diabetes as well as treatments and medications related to each Establishes a trusting relationship with identified patients, caregivers, clinic staff members and physicians Conducts clinic one-on-one visits with Disease Management Chronic Care Program participants - utilizing the Chronic Care Model - to assess patient needs for DME, home health, value-added services and any other necessary resources Communicates these needs to the appropriate person (i.e. Social Worker, clinic staff, etc.) or addresses them per process Solves problems by gathering and / or reviewing facts and selecting the best solution from identified alternatives Decision making is usually based on prior practice or policy, with some interpretation. Applies individual reasoning to the solution of a problem devising or modifying processes and writing procedures Serves as a resource or consultant for LVN team members Attends educational offerings to keep abreast of change and complies with licensing requirements, ensures all patient educational materials are up-to-date, and maintains knowledge of specialty and ancillary provider contract contents, to include exclusions and contract terms Collaborates with the nurse manager to recommend policies, procedures and standards which affect the care of the patient with high-risk chronic disease diagnoses such as CHF, IHD, COPD / Asthma and Diabetes Exhibits professionalism and is courteous with all patients, physicians and co-workers Performs all other related duties as assigned
Required Qualifications:Registered Nurse with a current license to practice in the state of employment Two or more years experience in a physician's office, clinical or hospital setting Cardiac, medical - surgical and / or critical care experience Proficient knowledge of chronic diseases, especially COPD / asthma, diabetes, CHF and IHD Experience related to patient education and / or motivational interviewing skills and self-management goal setting Excellent verbal and written skills Ability to interact productively with individuals and with multidisciplinary teams Proficient computer skills, including Microsoft Word, Excel, Access and Outlook Excellent organizational and prioritization skills Ability to lift up to 50 pounds Ability to push or pull heavy objects using up to 100 pounds of force Ability to sit for extended periods of time Ability to use fine motor skills to operate office equipment and / or machinery Ability to receive and comprehend instructions verbally and / or in writing Ability to use logical reasoning for simple and complex problem solving Bilingual (English / Spanish) language proficiency 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 managed care, referral processes, claims and ICD-9 and CPT coding 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, RN, Case Manager, Health Coach, McAllen, Harlingen, RGV, Rio Grand Valley, Texas, TX, WellMed, UHG
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 t...hey 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.