Sign In
 [New User? Sign Up]
Mobile Version

RN--Audit Case Manager - WellMed - El Paso, Corpus Christi or Rio Grande Valley, TX

UnitedHealth Group

El Paso, TX
Job Code:
Apply on the Company Site
  • Save Ad
  • Email Friend
  • Print
  • Research Salary

Job Details

RN--Audit Case Manager - WellMed - El Paso, Corpus Christi or Rio Grande Valley, TX(Job Number:713558)

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 primary responsibility of the 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 Case Manager  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 Case Manager will participate in integrated care team conferences to review clinical assessments, update care plans and determine follow-up frequency with the team. The Case Manager performs telephonic and face to face assessments. 




Please note: This position will be both office based and will require travel as needed. The RN in this role can be based in El Paso, Corpus Christi or the Rio Grande Valley. The RN will be responsible for peer to peer training and auditing as needed or directed by the manager.


Primary Responsibilities:

  • 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 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

  • Performs all other related duties as assigned




Job Case Management
Primary Location US-TX-El Paso
Other Location US-TX-Rio Grande Valley, US-TX-Corpus Christi
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Powered By

Featured Jobs[ View All ]

Featured Employers [ View All ]