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

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)

As a Field-Based Case Manager, you'll wear many hats, and work in a variety of environments. Sometimes, you'll interact with members leaving the hospital - possibly with new medications or diagnoses. Or perhaps you'll perform home visits, assisting members with safe, effective transitions from care environments to where they live. You may also act as an intermediary between providers and members - serving in numerous roles, such as educator, evaluator, service coordinator, community resource researcher and more. The result? Fewer hospitalizations, ER visits and costly service gaps; and a less stressed, more effective health care system for us all. Want more flexibility, want more autonomy? Work from your own home and coordinate a visiting schedule that is mutually beneficial to you and the members we serve.
What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.

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Work schedule will be M-F 8-5, Rotate ever other Saturday.

Job Summary

The Telephonic RN Care Coordinator temporary 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

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


• Possess 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


• Assist 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


• Provide 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

Minimum Required Education, Experience & Skills

• Graduate of an Associates 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

Preferred Education, Experience & Skills

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


• Experience working with psychiatric and geriatric patient population


• Bilingual (Spanish)

Physical & Mental Requirements:

• 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


• Ability to use fine motor skills to operate office equipment and/or machinery


• Ability to properly drive and operate a company vehicle


• Ability to receive and comprehend instructions verbally and/or in writing

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 90,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team 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. Certain positions are subject to random drug testing.

Job Keywords: Telephonic RN Care Coordinator, Registered Nurse, RN, Case Management, Bilingual, San Antonio, TX, Texas