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Registered Nurse Case/Utilization Manager Compact License
UnitedHealth Group - San Antonio, TX
posted about 1 month ago
About the position
The Nurse Case Manager II (NCM) is responsible for managing patient cases, focusing on longitudinal engagement, discharge planning, and outpatient management. This role involves coordinating care for patients with multiple co-morbidities, developing action plans, and ensuring continuity of care in collaboration with healthcare teams. The NCM will also provide health education and support to patients and their families, acting as an advocate throughout the healthcare system.
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.
- Identify patient needs, close healthcare gaps, and prioritize goals.
- Develop interventions using evidence-based practices while considering member barriers.
- Conduct 'welcome home' calls to ensure discharged patients receive necessary services according to their transition plan.
- Perform transition discharge assessments to identify member needs at the time of transition to a lower level of care.
- Serve as the clinical liaison with hospital and clinical staff, reviewing clinical authorizations for inpatient care.
- Make referrals to community sources and programs in partnership with the care team.
- Utilize motivational interviewing techniques to gather health history and determine health literacy.
- Manage assessments regarding patient treatment plans and establish collaborative relationships with healthcare providers.
- Collaborate with the Interdisciplinary Care Team to create individualized transition and action plans for patients.
- Confer with UM Medical Directors regarding inpatient cases and participate in departmental huddles.
- Maintain knowledge of utilization management processes and current standards of care for transition planning activities.
- Manage assigned caseload efficiently and document accurately to comply with requirements.
Requirements
- Associate's degree in Nursing
- Current, unrestricted RN license specific to the state of employment
- Case Management Certification (CCM) or ability to obtain within 12 months after the first year of employment
- 3+ years of diverse clinical experience, preferably with acutely ill patients
- 3+ years of managed care and/or case management experience
- Proven knowledge of utilization management, quality improvement, and discharge planning
Nice-to-haves
- Experience working with psychiatric and geriatric patient populations
- Ability to read, analyze, and interpret medical records and health plan documents
- Problem-solving skills and ability to identify community resources
- Planning, organizing, conflict resolution, negotiating, and interpersonal skills
- Critical thinking skills and nursing judgment
- Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
Benefits
- Comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
