Practice Care Manager, RN - Clarksdale, MS - Full-time / Part-time

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The Practice Care Manager (PCM) works with Community Plan leaders and leadership of assigned hospitals and physician practices in each Accountable Care Community.   PCM assumes responsibility for practices' high risk Health Plan members, and facilitates practices transformation from a reactive model of patient care to a proactive model by using practices population data to effectively measure, monitor and manage care, and presents outcomes to leadership in the Health Plan, the practices and the hospital.

PCM helps practices with transformation initiatives to improve Plan member access to care, manage member inpatient and ER care transitions, and manage high risk patients through pre-visit planning, addressing open care opportunities, managing referrals end to end and assuming responsibility for high risk member care coordination to reduce adverse events for patients.

The PCM is responsible for care management of the practices' high risk members  and assisting the practices in implementing the United Accountable Care Communities program in the following key areas: 

- Access to Care

Improve convenient access to care for the practices' Health Plan population.  Help practice leaders understand overall capacity/demand for appointments and visit patterns by practice and assist the Practices in implementing process improvements to increase same day visits and reduce no show rates. 

- Avoidable ER Use

Reduce inappropriate ER use for the practices' Plan population.  Collaborate with practices to use daily hospital ADT and daily ER notifications to engage members to use PCP for primary care. 

- Avoidable Inpatient Admissions/30 Day Readmissions

Reduce avoidable admissions and readmissions for the practice Plan population. Support practices in the effective use of the Accountable Care Population Registry to track and manage care transitions of all discharges and ensure follow up with a clinician within 7 days of discharge date.  .  Measure and monitor success of outreach and develop strategies to simplify processes and ensure optimal care for patients.

- Improve care of high risk/high cost cohort patients

Use predictive modeling analyses of practice population risk and population total costs of care and assist practices in identifying cohorts of high risk/high cost patients for focused improvement initiatives. Collaboratively establish practice clinical leadership measurable goals for each cohort to increase access with local Community Plan leaders, address current care gaps, improve subspecialty referral management, and reduce adverse events.

- Disease management

Disease Management and lower level Case Management (completion of a HRA, Disease Management assessment, and creation of individual plan of care)

- Active Pre Visit Planning

Increase percentage of patients with a PCP visit and/or behavioral health visit at least every 90 days. Practice Care Manager works on site with practice clinical teams and, when necessary, engages Community Health Workers to outreach and engage patients to ensure compliance. .  Ensure there is structured pre-visit planning for every PCP visit of high risk/high cost patients.

- Day of Visit

Practice Care Manager meets with high risk/high cost patients on arrival and completes medication review. PCM ensures that planned care opportunities are addressed by PCP and that the patient schedules next clinic visit. 

- Post Visit Follow up

Improve subspecialty referral end to end processes by monitoring high risk/high cost patient follow up with community and subspecialist referrals.  Ensure there is systematic and timely subspecialty consultation reporting to the PCP Practice and that all subspecialty recommendations are completed.  Ensure appropriate PCP follow-up after subspecialty referral.

- Practice Transformation

Assist practices in creating work flows to optimize care delivery, introduce best practices improvements, measurement processes and evaluate outcomes.  Meet on site with practice staff and/or hospital staff at least one day each week, to facilitate team training. Assess progress and address barriers.

- Collaborate with hospital teams and practice team for transitional needs of high risk patients.

- Participate in practice clinical team daily huddles, weekly operations reviews and monthly Joint Operating Committee (JOC) meetings with United, practices and hospital leaders to report progress on high risk patients.  Prepare and present progress against goals monthly at on site JOCs with United/ Practice/ hospital executive teams.

- Support practice in implementing process improvements to assist the practice in becoming a certified Medical Home, if desired by practice leaders.

Care Management

• Improve care of high risk patients – provide the practice with analyses of population risk and assist Practice in identifying Level 2 and 3 high risk patients for PCM focused care management


• Work collaboratively with the Behavioral Health Care Advocates to provide an integrated approach to health management.  PCM will make field visits on high risk members as the need is determined by issues of member compliance or situational barriers to care access


• The PCM will work directly with the Chief Medical Officer, Health Services Director, and the Senior Case Manager of the health plan and is expected to have a working understanding of the Health Plan's overall operations, benefits and resources in order to be a health advocate for the member for the Health Plan


• Participate  in weekly Case Management Rounds with Health Plan, responsible for updating accurate member information in Care One, and participating  with other Health Plan  members (Clinical Practice Consultants, Provider Advocates, Quality Division staff, Community Outreach staff, etc.) to unify access ensure care management to HP for the practices


• The PCM may also carry a case load with direction from the health plan

Disease Management

• Provides Disease Management for the following targeted Disease, to include Asthma, Diabetes, COPD, Obesity, CHF, Hypertension and Organ Transplant.  Other diseases at the direction of Chief Medical Officer, as utilization trends are noted


• Provides aggressive member outreach to increase participation, PCM-member relationships, and build trust and support,   by providing Disease specific educational material/mailers for the members


• Provides specific education regarding condition specific education and interventions to address self- management of chronic conditions


• Performs condition specific supplemental assessments  for members as appropriate

Required Qualifications:

• RN licensed in the state of MS


• 5+ years of demonstrated clinical experience


• 2+ years of case management and/or disease management


• Knowledge of  Medicaid and community care model


• Experience managing change initiatives for health care teams


• Strong process improvement skills


• Ability to organize and thrive in a fast-paced environment


• Strong interpersonal skills that enable relationship building


• Effective oral and written communication skills


• Ability to manage results of outcome measures and assist physician practice in creating solutions


•  Demonstrated evidence of innovative thinking and program development to make the health care system work better


• Ability to work independently with minimal supervisory oversight


• High level of computer literacy with clinical documentation system experience and strong ability to navigate without assistance in multiple computer applications and systems

Preferred Qualifications:

• BSN


• CCM


• Managed Care experience


• Ambulatory or Hospital Based Case experience

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. (sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: RN, case management, Medicaid, Clarksdale, MS, Mississippi