LVN/LPN CM/UM Unplanned Inpatient Admission Review UIAR Position Available In Ascension, Louisiana

Job Description:

WellMed, part of the Optum family of businesses, is seeking aLicensed Vocational Nurse LVN or LPN CM or UM Unplanned InpatientAdmission Review

• UIAR to join our team in Texas.

Optum is aclinician-led care organization that is changing the way clinicianswork and live. As a member of the Optum Care Delivery team, you’llbe an integral part of our vision to make healthcare better foreveryone. At Optum, you’ll have the clinical resources, data andsupport of a global organization behind you so you can help yourpatients live healthier lives. Here, you’ll work alongside talentedpeers in a collaborative environment that is guided by diversityand inclusion while driving towards the Quadruple Aim. We believeyou deserve an exceptional career, and will empower you to liveyour best life at work and at home. Experience the fulfillment ofadvancing the health of your community with the excitement ofcontributing new practice ideas and initiatives that could helpimprove care for millions of patients across the country. Becausetogether, we have the power to make health care better foreveryone. Join us and discover how rewarding medicine can be whileCaring. Connecting. Growing together. The Nurse Case Manager I(NCM) is responsible for patient case management for longitudinalengagement, coordination for discharge planning, transition of careneeds and outpatient patient management through the care continuum.

The Nurse Care Manager will determine medical appropriateness ofoutpatient services following evaluation of medical guidelines andbenefit determination. The Nurse Case Manager will coordinate, orprovide appropriate levels of care under the direct supervision ofan RN or MD. Function is responsible for clinical operations andmedical management activities across the continuum of care(assessing, planning, implementing, coordinating, monitoring andevaluating). This includes case management, coordination of care,and medical management consulting. Function may also be responsiblefor providing health education, coaching and treatment decisionsupport for patients. This role acts as a support to team members,coaching, guiding and providing feedback as necessary. The NurseCase Manager will act as an advocate for patients and theirfamilies guide them through the health care system for transitionplanning and longitudinal care. The Nurse Case Manager will work inpartnership with an assigned Care Advocate and Social Worker. Ifyou are located within the San Antonio, TX area and have a Compactlicense, you will have the flexibility to work remotely

• as youtake on some tough challenges.

Primary Responsibilities:

• Engagepatient, family, and caregivers telephonically to assure that awell-coordinated action plan is established and continually assesshealth status
• Provide member education to assist withself-management goals; disease management or acute condition andprovide indicated contingency plan
• Identify patient needs, closehealth care gaps, develop action plan and prioritize goals
• Withoversight of RN and/or MD, utilizing evidence-based practice,develop interventions while considering member barriersindependently
• Provide patients with “welcome home” calls toensure that discharged patients’ receive the necessary services andresources according to transition plan
• In partnership with careteam triad, make referrals to community sources and programsidentified for patients
• Utilize motivational interviewingtechniques to understand cause and effect, gather or review healthhistory for clinical symptoms, and determine health literacy
• Manages assessments regarding patient treatment plans and establishcollaborative relationships with physician advisors, clients,patients, and providers
• Collaborates effectively withInterdisciplinary Care Team (IDCT) to establish an individualizedtransition plan and/or action plan for patients
• Independentlyconfers with UM Medical Directors and/ or Market Medical Directorson a regular basis regarding inpatient cases and participates indepartmental huddles
• Demonstrate knowledge of utilizationmanagement processes and current standards of care as a foundationfor utilization review and transition planning activities
• Maintain in-depth knowledge of all company products and services aswell as customer issues and needs through ongoing training andself-directed research
• Manage assigned caseload in an efficientand effective manner utilizing time management skills
• Enterstimely and accurate documentation into designated care managementapplications to comply with documentation requirements and achieveaudit scores of 95% or better on a monthly basis
• Maintain currentlicensure to work in state of employment and maintain hospitalcredentialing as indicated
• Performs all other related duties asassigned In 2011, WellMed partnered with Optum to provide care topatients across Texas and Florida.

WellMed is a network of doctors,specialists and other medical professionals that specialize inproviding care for more than 1 million older adults with over16,000 doctors’ offices. At WellMed our focus is simple. We’reinnovators in preventative health care, striving to change the faceof health care for seniors. WellMed has more than 22,000 primarycare physicians, hospitalists, specialists, and advanced practiceclinicians who excel in caring for 900,000 older adults. Together,we’re making health care work better for everyone. You’ll berewarded and recognized for your performance in an environment thatwill challenge you and give you clear direction on what it takes tosucceed in your role as well as provide development for other rolesyou may be interested in.

Required Qualifications:

• HS Diploma orGED
• Current, unrestricted LPN/LVN license, specific to the stateof employment
• Texas or Compact
• 2 years of managed care and/orcase management experience
• 2 years of clinical experience
• Knowledge of managed care, medical terminology, referral process,claims and ICD-10 codes

Preferred Qualifications:

• Case Managementcertification
• Knowledge of utilization management and/orinsurance review processes as well as current standards of care, asolid knowledge of health care delivery systems and the ability tointeract with medical directors, physician advisors, clinicians andsupport staff
• Proficient computer skills in Microsoftapplications and Microsoft Excel
• Proven skills in planning,organizing, conflict resolution, negotiation and interpersonalskills to work with autonomy in meeting case management goals andinitiatives
• Proven ability to work independently in accomplishingassignments, program goals and objectives
• Proven excellentwritten and verbal skills
• All employees working remotely will berequired to adhere to UnitedHealth Group’s Telecommuter Policy Payis based on several factors including but not limited to locallabor markets, education, work experience, certifications, etc.

Inaddition to your salary, we offer benefits such as, a comprehensivebenefits package, incentive and recognition programs, equity stockpurchase and 401k contribution (all benefits are subject toeligibility requirements). No matter where or when you begin acareer with us, you’ll find a far-reaching choice of benefits andincentives. The hourly pay for this role will range from $20.00 to$35.72 per hour based on full-time employment. We comply with allminimum wage laws as applicable. OptumCare is an Equal EmploymentOpportunity employer under applicable law and qualified applicantswill receive consideration for employment without regard to race,national origin, religion, age, color, sex, sexual orientation,gender identity, disability, or protected veteran status, or anyother characteristic protected by local, state, or federal laws,rules, or regulations. OptumCare is a drug-free workplace.

Candidates are required to pass a drug test before beginningemployment.