Registered Nurse Outpatient Case Manager Healthcare WellMed San Antonio Texas in San Antonio, TX for Optum (2025)

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Internal Number: 142565725

WellMed, part of the Optum family of businesses, is seeking a Registered Nurse Outpatient Case Manager to join our team in San Antonio, TX. 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 at home. Experience 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 primary responsibility of the OP Case Manager is to identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a case management care plan. They will interact and collaborate with interdisciplinary care team (IDT), which includes physicians, inpatient case managers, care team associates, pharmacists, social workers, educators, health care coordinators/managers. The Case Manager also acts as an advocate for members and their families linking them to other IDT members to help them gain knowledge of their disease process(s)and to identify community resources for maximum level of independence. The Case Manager will participate in IDT conferences to review care plan and member progress on identified goals and interventions. The Case Manager may perform telephonic and/or face-to-face assessments.

Primary Responsibilities:

• Independently conducts initial assessments within designated timeframes for members identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
• Collaborates effectively with IDT to establish an individualized care plan for members with interventions to assist the member in meeting short- and long-term goals
• Engages patient, family, and caregivers to assure that a well-coordinated care plan is established
• Identifies member needs, develop care plan and prioritize goals; using evidence-based practice the Case Manager will develop interventions while considering member barriers independently
• Makes outbound calls to assess member health status, identify gaps or barriers in care plan
• Provides member education to assist with self-management goals
• Makes referrals to outside sources
• Educates members on disease process or acute condition and provide indicated contingency plan
• Coordinates visits with PCP and specialists as needed on a limited basis, performs visual assessment for skin checks on exposed skin, and conducts home safety evaluation
• Independently confers with Market MD Medical Directors and/or PCPs on a regular basis regarding Complex Care/High Risk Population members and participates in department huddles
• Enters timely and accurate data into designated care management applications and maintains audit scores of 95% or better monthly
• Adheres to organizational and departmental policies and procedures
• The Case Manager will also maintain current licensure to work in state of employment. Decision making is based on regulatory requirements, policies and procedures, and current clinical guidelines
  • Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
• Monitors for quality concerns regarding member care and reports as per policy and procedure
• Performs all other related duties as assigned

Full-Time Hybrid-IH10W/Office/Field Base Position: This position requires 25% - 50% traveling around the San Antonio, TX, and counties areas: Coordinating weekly visits with PCP and specialists as needed on a limited basis, performing visual assessment for skin checks on exposed skin, and conducts home safety evaluation.

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:

• Associate’s degree in Nursing
• Current unrestricted Registered Nurse license, specific to the state of employment
• Case Management certification (CCM) or ability to obtain CCM within 12 months after the first year of employment
• 3+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
• 3+ years of managed care and/or case management experience
• Experience utilizing planning, organizing, conflict resolution, negotiating and interpersonal skills
• Experience utilizing critical thinking skills, nursing judgement and decision-making skills; Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously
• Knowledge of utilization management, quality improvement and discharge planning
• Proficient with Microsoft Office applications including Outlook, Word, and Excel
• Demonstrated ability to read, analyze, interpret information in medical records and health plan documents
• Demonstrated ability to problem solve and identify community resources
• Proven ability to stand, walk or sit for long periods
• Access to reliable transportation

Preferred Qualification:

• Experience working with psychiatric and geriatric patient populations

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.