Telephonic RN Case Manager - Remote in Dallas Texas

Optum - Irving, TX

Full-time - Mid Level

Remote - Irving, TX

5,001-10,000 employees

Insurance Carriers and Related Activities

About the position

The Telephonic RN Case Manager role at WellMed, part of the Optum family, involves providing comprehensive care management for patients, focusing on assessment, planning, facilitation, care coordination, evaluation, and advocacy. This position is designed to ensure that patients receive high-quality, cost-effective care tailored to their individual health needs. The role is remote, allowing flexibility for those located in Texas, and operates Monday to Friday, with no weekend or holiday work required.

Responsibilities

• Engage and provide care management to commercial patient populations identified from the Health Plan, clinical meetings, outlier reports, plan specific insights, and predictive modeling.
• Complete Transition of Care follow up and assessment post discharge.
• Provide care management telephonically.
• Complete required assessments.
• Create a personalized care plan for each patient involved in care management to resolve barriers to care, close quality gaps in care, build additional education or contingency planning and engage with social support systems as appropriate.
• Regularly interact with health plan clinical programs and clinical personnel for care coordination.
• Complete all necessary care coordination and or assessment activities as outlined in the care plan.
• Attend telephonic patient care conferences/meetings with the clinic or health plan on assigned patients involved in care management at least monthly or as needed.
• Participate in internal JOC meetings for plan specific insights, best practices and intervention development weekly and as needed.
• Document all patient care activities into electronic database.
• Meet required Key Performance Indicators and pass Quality Audit metrics.
• Coordinate and cooperate with other members of the care management team.
• Support team through onboarding and training of new hire members.
• Perform other duties as assigned.

Requirements

• Current, unrestricted RN license, specific to the state of employment including ability to obtain additional state licenses.
• 3+ years of experience in a hospital, acute care or direct care setting.
• Proficiency in Microsoft Office products including Access, Excel, Word, PowerPoint and Outlook.
• Ability to attend occasional staff meetings onsite at the DSW office.
• Access to high-speed internet and a distraction-free workspace.

Nice-to-haves

• Case Management Certification (CCM).
• Managed care and/or care management experience.
• Experience in completion of assessment, care plans, care coordination and issue resolution.
• Electronic case management and medical record experience.
• Demonstrated skills in negotiation, communication (verbal and written), conflict resolution, interdisciplinary collaboration, management, creative problem solving, and critical thinking.
• Knowledge of healthcare reimbursement, Utilization Management, discharge planning, Disease Management.
• Intermediate knowledge of Commercial Plans, applicable state Department of Insurance regulations and health plans.
• Knowledge of NCQA standards in Primary Care Medical Home and Care Management, as well as Accountable Care Organization.
• Demonstrated ability to work remotely.
• Patient engagement experience including solid telephonic motivational interviewing skills.

Benefits

• Flexible work schedule with no weekends or holidays.
• Opportunities for professional development and career growth.
• Supportive team environment with a focus on patient care.