Case Manager, LVN or LPN - WellMed at Weatherford

UnitedHealth Group • Weatherford, TX

416d

About The Position

The Nurse Case Manager I (NCM) at WellMed is responsible for managing patient cases throughout the care continuum, focusing on discharge planning, transition of care, and outpatient management. This role involves evaluating the appropriateness of outpatient services, coordinating care under the supervision of an RN or MD, and providing health education and support to patients and their families. The NCM acts as an advocate for patients, ensuring they receive necessary services and resources while collaborating with interdisciplinary teams to develop individualized care plans.

Requirements

• Licensed Practical/Vocational Nurse with a current, unrestricted LPN/LVN license specific to the state of employment.
• 2+ years of managed care and/or case management experience.
• 2+ years of clinical experience.
• Knowledge of managed care, medical terminology, referral processes, claims, and ICD-10 codes.
• Proven excellent verbal and written communication skills.
• Tuberculosis screening and proof of immunity to certain diseases required.

Nice To Haves

• Case Management certification.
• Knowledge of utilization management and/or insurance review processes and current standards of care.
• Solid knowledge of healthcare delivery systems and ability to interact with medical directors and clinicians.
• Proficient computer skills in Microsoft applications and Excel.
• Skills in planning, organizing, conflict resolution, negotiation, and interpersonal skills.

Responsibilities

• Engage patient, family, and caregivers telephonically to establish a coordinated action plan and assess health status.
• Provide member education to assist with self-management goals and develop contingency plans for disease management or acute conditions.
• Identify patient needs, close healthcare gaps, and develop action plans with prioritized goals.
• Develop interventions utilizing evidence-based practice while considering member barriers, under the oversight of RN and/or MD.
• Provide 'welcome home' calls to discharged patients to ensure they receive necessary services according to the transition plan.
• Make referrals to community sources and programs in partnership with the care team triad.
• Utilize motivational interviewing techniques to gather health history and determine health literacy.
• Manage assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers.
• Collaborate with the Interdisciplinary Care Team (IDCT) to establish individualized transition and action plans for patients.
• Confer regularly with UM Medical Directors and/or Market Medical Directors regarding inpatient cases and participate in departmental huddles.
• Demonstrate knowledge of utilization management processes and current standards of care for utilization review and transition planning activities.
• Maintain in-depth knowledge of company products and services through ongoing training and self-directed research.
• Manage assigned caseload efficiently and effectively using time management skills.
• Enter timely and accurate documentation into care management applications to comply with documentation requirements and achieve audit scores of 95% or better.
• Maintain current licensure and hospital credentialing as indicated.
• Perform all other related duties as assigned.

Benefits

• Opportunities for professional development and career growth.
• Recognition for performance in a challenging environment.

What This Job Offers

• Job Type: Full-time
• Industry: Insurance Carriers and Related Activities
• Education Level: Associate degree