Bilingual 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) 
 
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
 
On-Site, Monday-Friday 8am-5pm & rotate every 5th Saturday
 
Primary Responsibilities:

Possess planning, organizing, conflict resolution, negotiating, collaborative and interpersonal skills to be used over the telephone
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
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

Required Qualifications:


Graduate of an Associates Degree Nursing (ADN) Program with a current license to practice in the applicable State

Diverse clinical experience with three 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 Qualifications:


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

Experience working with psychiatric and geriatric patient population
Bilingual Strongly Preferred (Spanish/English)
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.
 
Job Keywords: RN, Registered Nurse, Telephonic, Call, Care Manager, Triage, San Antonio, TX, Texas, Bilingual, Case Manager