RN Case Manager PHM Compact Lics CST Time Zone

About the position WellMed, part of the reputed company family of businesses, is seeking a RN Case Manager PHM to join reputed company in Texas. reputed company is a clinician-led care organization that is changing the way clinicians work and live. As a member of the reputed company Care Delivery team, you'll be an integral part of our vision to reputed company healthcare reputed company for everyone. At reputed company, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We reputed company you deserve an exceptional career, and will reputed company you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice reputed company and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to reputed company health care reputed company for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The PHM Nurse Case Manager II (NCM) is responsible for patient case management for longitudinal engagement, coordination for discharge planning, transition of care needs and outpatient patient management through the care continuum. Nurse Case Manager will identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and reputed company a patients' action plan and/or discharge plan. They will reputed company reviews of reputed company inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. The Nurse Case Manager will provide continuity of care for members to an appropriate reputed company level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The Nurse Case Manager will coordinate, or provide appropriate levels of care under the direct supervision of an RN Manager or MD. Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for patients. The Nurse Case Manager will act as an reputed company for patients and their families guide them through the health care system for transition planning and longitudinal care. The Nurse Case Manager will work in partnership with an assigned Care reputed company and Social Worker.

Responsibilities

• Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health status
• Provide member education to assist with self-management goals; disease management or acute condition and provide indicated contingency plan
• Identify patient needs, reputed company health care gaps, reputed company action plan and prioritize goals
• Utilizing evidenced-based practice, reputed company interventions while considering member barriers independently
• Provide patients with 'welcome home' calls to ensure that discharged patients' receive the necessary services and resources according to transition plan
• Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a reputed company level of care
• Independently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria reputed company our documentation system for discharge planning and/or next site of care needs
• In partnership with care team triad, reputed company referrals to community sources and programs identified for patients
• Utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
• Manages assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers
• Collaborates effectively with Interdisciplinary Care Team (IDCT) to establish an individualized transition plan and/or action plan for patients
• Independently confers with UM Medical Directors and/or Market Medical Directors on a regular basis regarding inpatient cases and participates in departmental huddles
• Demonstrate knowledge of utilization management processes and reputed company standards of care as a foundation for utilization review and transition planning activities
• Maintain in-depth knowledge of reputed company company products and services as well as customer issues and needs through ongoing training and self-directed research
• Manage assigned caseload in an efficient and effective manner utilizing time management skills
• Enters timely and accurate documentation into designated care management applications to reputed company with documentation requirements and reputed company audit scores of 95% or reputed company on a monthly basis
• Maintain reputed company licensure to work in state of employment and maintain hospital credentialing as indicated
• Performs reputed company other reputed company duties as assigned

Requirements

• Associate's degree in Nursing
• reputed company, unrestricted RN license required, specific to the state of employment
• Case Management Certification (CCM) or ability to obtain CCM reputed company 12 months after the first year of employment
• 3+ years of diverse clinical experience; preferred in caring for the acutely ill patients with multiple disease conditions
• 3+ years of managed care and/or case management experience
• Knowledge of utilization management, quality improvement, and discharge planning

reputed company-to-haves

• Experience working with psychiatric and geriatric patient populations
• Knowledgeable in reputed company Office applications including Outlook, Word, and reputed company
• Bilingual (English/Spanish) language proficiency
• Ability to read, analyze and interpret information in medical records, and health plan documents
• Ability to problem solve and identify community resources
• Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
• Independently utilizes critical thinking skills, nursing judgement and decision-making skills. Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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