Senior Case Manager RN, Team Lead – Richardson, TX
Job Description
Optum
Internal Number: 144494932
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
As a Senior Case Manager, you will assist with escalated cases and internal / external vendor interface, participate in customer calls and meetings as required; coach staff on team, complete quality case and call audits; conduct phone calls to consumers if needed to achieve the team outreach goals or coverage for case managers.
Must be interested in career path as a Clinical Manager. Position will also review patient status over the phone while ensuring they are receiving the best care.
Primary Responsibilities:
- Serve as a mentor and coach to staff case managers
- Handle escalated cases from team
- Interact directly with vendors and account management
- Make outbound calls to assess members’ current health status
- Identify gaps or barriers in treatment plans
- Provide patient education to assist with self-management
- Interact with Medical Directors on challenging cases
- Coordinate care for members
- Make referrals to outside sources
- Coordinate services as needed (home health, DME, etc.)
- Educate members on disease processes
- Encourage members to make healthy lifestyle changes
- Document and tracking findings
- Make post – discharge calls to ensure that discharged member receive the necessary services and resources
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
- Current, unrestricted RN license in the State of Residence
- Willingness and ability to obtain additional licensures as needed
- Ability to obtain CCM within 24 months of assuming role
- 3+ years of RN experience in a hospital setting, acute care, direct care experience
- 1+ years of experience as a Case Manager in a managed care setting
- 1+ years of demonstrated leadership background
- Computer proficiency, to include strong data entry skills and the ability to navigate a Windows environment
Preferred Qualifications:
- BSN or Masters degree
- Medical / Surgical, Home Health, Diabetes or Cardiac experience (certification in one of those specialties)
- Experience in managed care
- Disease management experience
- Experience / exposure with discharge planning
- Bilingual (Spanish / English) skills
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.
Source ⇲
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