Telephonic RN Care Coordinator - San Antonio, TX - Full-time / Part-time

The Telephonic RN Care Coordinator position is primarily responsible for successfully completing telephonic member evaluations to ensure compliance with CMS and NCQA requirements.  The RN acts as an educator, resource, and advocate for members and their families to ensure a maximum level of independence.  The RN will interact and collaborate with a multidisciplinary care team, which includes physicians, nurses, case managers, social workers and other educators to develop educational strategies and care management interventions that will assist in maximizing patient outcomes. 

Days/ Shifts:  Candidate must be able to work: Monday- Friday: 8 a.m.- 5p.m. Rotating Saturdays every other 6 weeks.

Essential Job Functions

• Possess planning, organizing, conflict resolution, negotiating, collaborative and interpersonal skills to be used telephonically


• Ability to perform at least 50 outbound calls per day and obtain at least 20 successful member contacts.  Ability to utilize a dialer program for incoming calls


• Performs telephonic member evaluations to establish educational and care management needs and provide effective educational techniques


• Remains knowledgeable about related high-risk diagnoses such as Diabetes, CHF, IHD, and COPD/Asthma


• Possesses planning, organizing, conflict resolution, negotiating, collaborative and interpersonal skills to be used telephonically


• Performs telephonic member evaluations to establish educational and care management needs and provide effective educational techniques


• Remains knowledgeable about related high-risk diagnoses such as Diabetes, CHF, IHD, and COPD/Asthma


• Assists in providing patient empowerment through use of motivation, supportive skills, problem solving, and self-management goal setting


• Collaborates with multidisciplinary care team including physicians, nurses, case managers, social workers and other educators/health coaches to identify and provide effective education techniques for plan member


• Evaluates effectiveness of teaching methods and provides feedback, recommendations and corrective action plans to the multidisciplinary care team for ensure patient progression toward goals


• Provides member enrollment into qualifying programs such as, but not limited to: Medication Voucher Programs, Diabetic supplies, Diabetic shoes


• Ensures all new initiatives, policies and procedures, guidelines or other necessary updates are incorporated into patient educational program to provide reconciliation and/or verification of status, conditions and/or medications


• Manages patient case load in an efficient and effective manner utilizing time management skills to facilitate the total work process


• Provides constructive information to minimize problems and increase customer satisfaction


• Seeks ways to improve job efficiency and makes appropriate suggestions following the appropriate chain of command


• Enters timely and accurate data into Disease Management and UM applications following NCQA guidelines for Disease Management documentation as needed to communicate patient needs


• Follows plan for professional development and actively seeks out opportunities to increase knowledge and expertise in nursing education


• Maintains knowledge of health plan benefits and provider network


• Participates in the development of appropriate QI processes, establishing and monitoring indicators


• Performs all duties for internal and external customers in a timely and responsible manner representing the company with the utmost professionalism


• Performs all other related duties as assigned

Required Qualifications:

• Graduate of an Associate's Degree Nursing (ADN) Program with a current license to practice in the applicable State


• Diverse clinical experience with five or more years' experience in caring for the acutely ill patients with multiple disease conditions


• Possess planning, organizing, conflict resolution, negotiating and interpersonal skills


• Proficient in PC software computer skills such as Microsoft Word, Excel, Power Point, and other departmental specific programs/applications


• Independent problem identification/resolution and decision making skills


• Must be able to prioritize, plan, and handle multiple tasks, demands simultaneously


• Ability to lift up to 100 pounds


• Ability to push or pull heavy objects using up to 25 pounds of force


• Ability to sit for extended periods of time

Preferred Qualifications:

• BSN degree with current RN license to practice in the applicable State


• Experience working with psychiatric and geriatric patient population


• Bilingual (Spanish)

WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.

Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.

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, 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: Utilization review, Case Management, RN, Registered Nurse, San Antonio, TX, Texas