RN Case Manager PHM Compact Lics DFW

Well Med, part of the Optum family of businesses, is seeking a RN Case Manager PHM to join our team in Texas. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, 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 believe you deserve an exceptional career, and will empower you to live your best life at work and erience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better 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 develop a patients’ action plan and/or discharge plan. They will perform reviews of current 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 lower 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 advocate 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 Advocate and Social Worker. If you have a Compact License, you will have the flexibility to work remotely • as you take on some tough challenges. Primary 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, close health care gaps, develop action plan and prioritize goals • Utilizing evidenced-based practice, develop 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 lower 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 within our documentation system for discharge planning and/or next site of care needs • In partnership with care team triad, make referrals to community sources and programs identified for patients • Utilize motivational interviewing… Apply Job!