RN (SCP) Case Manager WellMed

Explore opportunities with WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will be part of a team who shares your passion for helping people achieve improved health outcomes. Explore rewarding opportunities for physicians, clinical staff and non-patient-facing roles. Join us and discover the meaning behind Caring. Connecting. Growing together. WellMed provides concierge - level medical care and service for seniors, delivered by physicians and clinic staff that understand and care about the patient's health. WellMed's proactive approach focuses on prevention and the complete coordination of care for patients. WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

The Specialized Clinical Programs (SCP) Case Manager may perform telephonic and/or face-to-face assessments including ongoing re-assessment, case planning, service coordination and monitoring of the services that eligible members with special needs receive. Collaborates with the member and other health care providers to facilitate member access to health and social services, foster adherence to efficient and cost-effective medical treatment regimens which enhance member's health and well-being. Facilitates a proactive partnership with members to enhance and personalize management of health-related needs. Conducts comprehensive assessment of needs, continuous care plan development, coordination and evaluation of member's services leading to the goal of equipping and empowering members and caregivers to easily access resources and adopt healthy lifestyles that will increase their ability to remain in the most appropriate care setting. Also responsible for providing health education, coaching and treatment decision support for members. Participates in Interdisciplinary Team conferences (IDT) to review care plan and member progress on identified goals and interventions. The SCP Case Manager will work in partnership with an assigned Care Navigator.

Primary Responsibilities

• Ability to assess a complex population and interpret member needs and requirement
• Perform individual health risk questionnaires assists with individualized care plan design, documentation and implementation of care plan activity, transitions of care coordination, and evaluation of outcomes
• Perform initial review of member's health records and current health status (e.g., health risk scores) to identify health risk and determine next steps
• Perform medication reconciliation
• Receive information from members about specific symptoms and answer questions
• Identifies the targeted high-risk population, and perform risk stratification
• Evaluate member data throughout the assessment process to identify inconsistencies and adherence to Evidence Based Guidelines
• Work to develop identified individualized interventions for members in care management
• Utilize Motivational Interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
• Utilizes critical thinking skills to solve complex problems and/or conduct complex analyses
• Identify and prioritize gaps to develop plan of care to empower members to meet identified goals
• Collaborate with members to set their own goals and align care activities with those goals
• Monitor progress of goals, adjust care needs accordingly
• Provide treatment recommendations and ongoing monitoring and evaluation of members
• Make follow-up calls to ensure members receive the necessary services, resources and care plan created with their nurse
• Assure appropriate and complete data entry of all documentation per guidelines
• Establish effective collaboration, communication and coordination among all responsible parties of a member's multidisciplinary health care team
• Collaborate with member's primary care physician and other providers/specialists of any potential problems as they become evident.
• Ensure members receive the proper level of care via coordination, assessment and interpretation of needs and requirements. Provide specific disease self-management education to members face-to-face and telephonically
• Coaches, provides education on disease processes, obtain feedback, and guide members on interventions to improve health outcomes
• Responsible for meeting CMS, NCQA, and all other regulatory compliance requirements for CMS Special Needs Program (SNP) Model of Care
• Adheres to quality standards, HIPAA, confidentiality, company policies, procedures and reporting requirements
• Actively participates in quality assessment/performance improvement program
• Works with minimal guidance; seeking guidance on only the most complex tasks
• Performs all other related duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Current, unrestricted RN license required, specific to the state of employment including ability to obtain additional state licenses as directed
• 5+ years of managed care and/or care management experience
• 5+ years of clinical experience
• Proven knowledge of managed care, medical terminology
• Proven excellent verbal and written skills
• Proficiency in Microsoft Office products including Access, Excel, Word, PowerPoint and Outlook
• Demonstrated skills in planning, organizing, conflict resolution, negotiation, critical thinking and interpersonal skills to work with autonomy
• Experience with CMS and NCQA requirements for Special Needs Programs
• Proficient experience in Medicare and Medicaid population
• Ability to work independently in accomplishing assignments, program goals and objectives
• Experience carrying caseload of members
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease

Preferred Qualifications

• Certified Case Manager (CCM)
• 10+ years of clinical experience
• 5+ years of case management experience, telephonic and/or face-to-face

Physical & Mental Requirements

• Ability to lift up to 10 pounds
• Ability to push or pull heavy objects using up to 10 pounds of force
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.