Case Manager, LVN or LPN - WellMed at University
Company: Optum
Location: Forney
Posted on: January 23, 2025
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Job Description:
WellMed, part of the Optum family of businesses, is seeking a
Case Manager, LVN or LPN - WellMed at University to join our team
in Dallas, TX. Optum is a clinician-led care organization that is
changing the way clinicians work and live.
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As a member of the Optum Care Delivery team, you'll be an integral
part of our vision to make healthcare better for everyone.
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At Optum, you'll have the clinical resources, data and support of a
global organization behind you so you can help your patients live
healthier lives. Here, you'll work alongside talented peers in a
collaborative environment that is guided by diversity and inclusion
while driving towards the Quadruple Aim. We believe you deserve an
exceptional career, and will empower you to live your best life at
work and at home. Experience the fulfillment of advancing the
health of your community with the excitement of contributing new
practice ideas and initiatives that could help improve care for
millions of patients across the country. Because together, we have
the power to make health care better for everyone. Join us and
discover how rewarding medicine can be while Caring. Connecting.
Growing together
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The Nurse Case Manager I (NCM) is responsible for patient case
management for longitudinal engagement, coordination for discharge
planning, transition of care needs and outpatient patient
management through the care continuum. The Nurse Care Manager will
determine medical appropriateness of outpatient services following
evaluation of medical guidelines and benefit determination. The
Nurse Case Manager will coordinate, or provide appropriate levels
of care under the direct supervision of an RN or MD. Function is
responsible for clinical operations and medical management
activities across the continuum of care (assessing, planning,
implementing, coordinating, monitoring and evaluating). This
includes case management, coordination of care, and medical
management consulting. Function may also be responsible for
providing health education, coaching and treatment decision support
for patients. This role acts as a support to team members,
coaching, guiding and providing feedback as necessary. The Nurse
Case Manager will act as an advocate for patients and their
families guide them through the health care system for transition
planning and longitudinal care. The Nurse Case Manager will work in
partnership with an assigned Care Advocate and Social Worker.
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Primary Responsibilities:
Engage patient, family, and caregivers telephonically to assure
that a well-coordinated action plan is established and continually
assess health status
Provide member education to assist with self-management goals;
disease management or acute condition and provide indicated
contingency plan
Identify patient needs, close health care gaps, develop action plan
and prioritize goals
With oversight of RN and/or MD, utilizing evidence-based practice,
develop interventions while considering member barriers
independently
Provide patients with "welcome home" calls to ensure that
discharged patients' receive the necessary services and resources
according to transition plan
In partnership with care team triad, make referrals to community
sources and programs identified for patients
Utilize motivational interviewing techniques to understand cause
and effect, gather or review health history for clinical symptoms,
and determine health literacy
Manages assessments regarding patient treatment plans and establish
collaborative relationships with physician advisors, clients,
patients, and providers
Collaborates effectively with Interdisciplinary Care Team (IDCT) to
establish an individualized transition plan and/or action plan for
patients
Independently confers with UM Medical Directors and/ or Market
Medical Directors on a regular basis regarding inpatient cases and
participates in departmental huddles
Demonstrate knowledge of utilization management processes and
current standards of care as a foundation for utilization review
and transition planning activities
Maintain in-depth knowledge of all company products and services as
well as customer issues and needs through ongoing training and
self-directed research -
Manage assigned caseload in an efficient and effective manner
utilizing time management skills
Enters timely and accurate documentation into designated care
management applications to comply with documentation requirements
and achieve audit scores of 95% or better on -
a monthly basis
Maintain current licensure to work in state of employment and
maintain hospital credentialing as indicated
Performs all other related duties as assigned
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In 2011, WellMed partnered with Optum to provide care to patients
across Texas and Florida. WellMed is a network of doctors,
specialists and other medical professionals that specialize in
providing care for more than 1 million older adults with over
16,000 doctors' offices. At WellMed our focus is simple. We're
innovators in preventative health care, striving to change the face
of health care for seniors. WellMed has more than 22,000+ primary
care physicians, hospitalists, specialists, and advanced practice
clinicians who excel in caring for 900,000+ older adults. Together,
we're making health care work better for everyone.
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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:
Licensed Practical/Vocational Nurse
Current, unrestricted LPN/LVN license required, 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 process,
claims and ICD-10 codes.
Proven excellent verbal and written skills
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Preferred Qualifications:
Case Management certification
Knowledge of utilization management and/or insurance review
processes as well as current standards of care, a solid knowledge
of health care delivery systems and the ability to interact with
medical directors, physician advisors, clinicians and support
staff
Proficient computer skills in Microsoft applications and Microsoft
Excel
Proven skills in planning, organizing, conflict resolution,
negotiation and interpersonal skills to work with autonomy in
meeting case management goals and initiatives
Demonstrated ability to work independently in accomplishing
assignments, program goals and objectives
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Physical & Mental Requirement:
Ability to properly drive and operate a company vehicle
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Diversity creates a healthier atmosphere: OptumCare is an Equal
Employment Opportunity/Affirmative Action employers and all
qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, age, national origin,
protected veteran status, disability status, sexual orientation,
gender identity or expression, marital status, genetic information,
or any other characteristic protected by law
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OptumCare is a drug - free workplace. Candidates are required to
pass a drug test before beginning employment.
Keywords: Optum, North Richland Hills , Case Manager, LVN or LPN - WellMed at University, Executive , Forney, Texas
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