RN Case Managers-WellMed, Fort Worth, TX

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.

WellMed is now part of the Optum division under the greater UnitedHealth Group umbrella.

Do you have compassion and a passion to help others?  Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work SM

No Weekends, No Evenings, No On Call!

The RN Case Manager is responsible for utilization management and inpatient care management coordination and will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services by following medical guidelines and benefit determination. They will also identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities, psychosocial needs, transition needs and develop a nursing plan of care as well as prospective, concurrent, and retrospective utilization review of inpatient services. The RN Case Manager acts as an advocate for members and their families by linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence.

The RN Case Manager is responsible for the case management activities across the continuum of care including coordination of care, medical management consulting and may also provide health education, coaching and treatment decision support for members. The RN Case Manager participates in interdisciplinary conferences and Patient Care Coordination Meeting (PCC) to review clinical assessments, update care plans and determine follow-up frequency with the team.

Responsibilities for Case Managers include:

-Making outbound calls to assess members' current health status
-Identifying gaps or barriers in treatment plans
-Providing patient education to assist with self-management
-Interacting with Medical Directors on challenging cases
-Coordinating care for members
-Making referrals to outside sources
-Coordinating services as needed (home health, DME, etc.)
-Educating members on disease processes
-Encouraging members to make healthy lifestyle changes
-Documenting and tracking findings  

-Utilizing Milliman criteria to determine if patients are in the correct hospital setting
-Making welcome home calls to ensure that discharged member receive the necessary services and resources

Requirements:

-Current, unrestricted RN license in the State of Texas
-2+ years' experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
-Basic level of experience with Microsoft Word

Additional Assets Preferred:
-Bachelor's Degree
-A background in managed care
-Case Management experience
-Certified Case Manager (CCM)
-Experience/exposure with discharge planning
-Experience in utilization review, concurrent review and/or risk management
-Strong organizational skills and multitasking abilities will be keys to success

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

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.

 Keywords:  Licensed Registered Nurse, RN, Chronic disease management, Case Management, Field Case Management, CM, CCM, Seniors, Clinic, Fort Worth, TX