RN Case Manager PHM Compact Lics DFW

$58,300 - $114,300/Yr

UnitedHealth Group - Fort Worth, TX

Full-time - Mid Level

Fort Worth, TX

Insurance Carriers and Related Activities

About the position

The PHM Nurse Case Manager II (NCM) is responsible for managing patient cases to ensure effective longitudinal engagement, discharge planning, and outpatient management. This role involves coordinating care for patients with multiple co-morbidities and psychosocial needs, developing action and discharge plans, and providing continuity of care in collaboration with healthcare teams. The Nurse Case Manager acts as an advocate for patients, guiding them through the healthcare system and ensuring they receive necessary services and resources.

Responsibilities

• Engage patients, families, and caregivers to establish and assess action plans.
• Provide member education to assist with self-management goals and disease management.
• Identify patient needs and develop action plans to close healthcare gaps.
• Conduct 'welcome home' calls to discharged patients to ensure they receive necessary services.
• Perform transition discharge assessments to identify member needs at lower levels of care.
• Serve as a clinical liaison with hospital and clinical staff for inpatient care authorizations.
• Make referrals to community resources and programs for patients in partnership with care teams.
• Utilize motivational interviewing techniques to gather health history and assess 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 plans.
• Confer with UM Medical Directors regarding inpatient cases and participate in departmental huddles.
• Maintain knowledge of company products and customer needs through ongoing training and research.
• Manage assigned caseload efficiently and document accurately to meet compliance requirements.

Requirements

• Associate's degree in Nursing
• Current, unrestricted RN license specific to the state of employment or a compact nursing license
• Case Management certification (CCM) or ability to obtain within 12 months 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
• Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
• Ability to read, analyze, and interpret medical records and health plan documents
• Demonstrated problem-solving skills and ability to identify community resources
• Proven planning, organizing, conflict resolution, and interpersonal skills
• Ability to utilize critical thinking and nursing judgment effectively

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution