1+ months

Case Manager II - Outpatient and Community Services - Harlingen, TX

Harlingen, TX 78550
  • Job Code
    849978

The primary responsibility of the Case Manager is to identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a case management plan of care. They will interact and collaborate with interdisciplinary care team, which includes physicians, transition care managers (i.e., UM inpatient case managers), referral coordinators, pharmacists, social workers, and other educators and nurses. The Case Manager also acts as an advocate for members and their families linking them to other members of the care team to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence. The Case Manager ill participate in integrated care team conferences to review clinical assessments, update care plans and determine follow-up frequency with the team. The Case Manager performs telephonic and face to face assessments.


Primary Responsibilities:

  • Conducts initial assessments within designated timeframes on patients identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
  • Collaborates effectively with integrated care team to establish an individualized plan of care for members. The integrated care team includes physicians, case managers, referral coordinators, pharmacists, social workers, and other disease educators. Develops interventions to assist the member in meeting short and long term plan of care goals
  • Engage patient, family, and caregivers to assure that a well coordinated treatment plan is established
  • Prioritize care needs, set goals and develop an initial plan of care that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation
  • Make outbound calls to assess member health status, identify gaps or barriers in treatment plans
  • Provide member education to assist with self- management goals
  • Make referrals to outside sources
  • Educate members on disease process or acute condition
  • Coordinates and attends member visits with PCP and specialists as needed in special circumstances
  • On a limited bases, a physical assessment may include taking of blood pressure, heart rate, respiratory assessment: Rate, effort, pulse oximetry, peripheral circulation and skin checks on exposed skin, foot checks for edema and skin integrity, home safety evaluation
  • Seeks ways to improve job efficiency and makes appropriate suggestions following the appropriate chain of command. 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
  • Performs all duties for internal and external customers in a professional and responsible manner having fewer than two complaints per year
  • Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a quarterly basis
  • Adheres to organizational and departmental policies and procedures. a. Takes on-call assignment as directed
  • Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms. a. With the assistance of the Managed Care/UM teams, guides physicians in their awareness of preferred contracts and providers and facilities
  • Attends educational offering to keep abreast of change and comply with licensing requirements and assists in the growth and development of associates by sharing knowledge with others.
  • Participates in the development of appropriate QI processes, establishing and monitoring indicators
  • Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • 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.
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Posted: 2019-11-01 Expires: 2019-12-29

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Case Manager II - Outpatient and Community Services - Harlingen, TX

UnitedHealth Group
Harlingen, TX 78550

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