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RN Clinic Case Manager - McAllen - WellMed

UnitedHealth Group

McAllen, TX
Job Code:
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Job Details

RN Clinic Case Manager - McAllen - WellMed(Job Number:725333)

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 Health Coach 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

Job Case Management
Primary Location US-TX-McAllen
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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