Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff, and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

　　The Nurse Case Manager I (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. The Nurse Care Manager will determine medical appropriateness of outpatient services following evaluation of medical guidelines and benefit determination. The Nurse Case Manager will coordinate or provide appropriate levels of care under the direct supervision of an RN 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. This role acts as a support to team members, coaching, guiding, and providing feedback as necessary. 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.

　　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 With oversight of RN and/or MD, utilizing evidence-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 In partnership with care team triad, make 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 The information listed above is not comprehensive of all duties/responsibilities performed This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice Demonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning activities Maintain in-depth knowledge of all 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 comply with documentation requirements and achieve audit scores of 95% or better on a monthly basis Maintain current licensure to work in state of employment and maintain hospital credentialing as indicated Performs all other related duties as assigned

　　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:

　　Licensed Practical/Vocational Nurse Current, unrestricted LPN/LVN license, specific to the state of employment 2+ years of managed care and/or case management experience 2+ years of clinical experience Excellent verbal and written skills Knowledge of managed care, medical terminology, referral process, claims and ICD-10 codes

　　Preferred Qualifications:

　　Case Management certification Skills in planning, organizing, conflict resolution, negotiation, and interpersonal skills to work with autonomy in meeting case management goals and initiatives Knowledge of utilization management and/or insurance review processes as well as current standards of care, a solid knowledge of health care delivery systems and the ability to interact with medical directors, physician advisors, clinicians, and support staff Ability to work independently in accomplishing assignments, program goals and objectives Proficient computer skills in Microsoft applications and Microsoft Excel

　　Physical & Mental Requirements:

　　Ability to lift up to 10 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 stand 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 Ability to use logical reasoning for simple and complex problem solving

　　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.