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RN Case Manager - Disease Management - San Antonio, TX

UnitedHealth Group


Location:
San Antonio, TX
Date:
08/15/2017
2017-08-152017-09-13
Job Code:
1750648
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Job Details


RN Case Manager - Disease Management - San Antonio, TX(Job Number:715700)
Description

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 Telephonic Case Manager is responsible for utilization management and inpatient care management coordination in a telephonic case management position. This position requires heavy telephonic use. The Case Manager will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. Generally work is self-directed and will require solving moderately complex problems and / or moderately complex analyses, including identifying solutions to non-standard requests and problems The Case Manager works under the direct supervision of an RN or MD and will act as a resource for others, coaching, guiding and providing feedback to others as necessary. This function is responsible for medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. The function may also be responsible for providing health education, coaching and treatment decision support for members and will work closely with management teams in the ongoing development and implementation of health services programs.
 
Primary Responsibilities:
  • The Case Manager serves as the telephonic clinical liaison with hospital clinical and administrative staff as well as providing expertise for clinical authorizations for inpatient care
  • Makes outbound calls to assess members' current health status
  • Performs case reviews telephonically for assigned inpatient facilities and skilled nursing facilities; advises supervisor 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 case management programs; makes "welcome home" calls to ensure that discharged member receive the necessary services and resources
  • Conduct Utilization Reviews (concurrent and retrospective reviews) using approved health plan guidelines such as Milliman Criteria and / or InterQual Criteria
  • Demonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and discharge planning activities
  • Confer with physician advisors on regular basis regarding inpatient cases and participate in utilization departmental rounds. Plans member discharges with providers
  • Track ongoing status of all certification activity and maintain continuing certification (or denial)
  • Make initial assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers
  • Adhere to quality standards and state UR guidelines, as well as confidentiality of all information, policies, and procedures. Adheres to company policies, procedures, and reporting requirements
  • Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
  • Continuous professional development about issues and trends in utilization review
  • Negotiate price, level of care, intensity, and duration of services as appropriate
  • Performs all other related duties as assigned

Job Case Management
Primary Location US-TX-San Antonio
Other Location 
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.

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