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The Nurse Case Manager is responsible for performing case management within the scope of licensure for patients with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring and evaluating care plans designed to optimize health care across the care continuum and ensuring patient access to services appropriate to their health needs. Basic counseling skills and a positive, enthusiastic and helpful personality are a must. Activities include coordination and oversite of care plans and services of a defined patient population program to promote effective utilization of services and quality patient care.
- Population Management
- Analyzes data related to patient populations/conditions and develops a plan of action. Monitors progress over time and initiates changes as needed.
- Identifies patient populations requiring care management support.
- Assesses patient populations to identify those resources or other factors needed to achieve the desired outcome for health maintenance or health improvement.
- Coordinates healthcare interventions for populations with significant health conditions in which self-management efforts are critical.
- Maintains appropriate patient educational materials for populations of patients to meet the needs of patients and families in order to assist with the facilitation of their participation in the plan of care.
- Develops strategies to meet the preventive care and health maintenance measures for populations of patients.
- Develops professional relationships with community resources that are used by OMG to care for populations of patients. (e.g. Home health, hospice)
- Disease Management
- Assists in the management of patients with chronic diseases following established protocols and systems for disease management in collaboration with providers.
- Assesses patient learning needs and has the ability to develop and implement individualized educational or care plans. Reviews, evaluates and revises the plan on an ongoing and timely basis. Develops self-management goals and monitors the progress of the goals.
- Communicates with a multidisciplinary team (physicians, nurses, therapists, social workers, etc.) as needed to assist with disease management.
- Has the ability to oversee and assist the patient with referral navigation.
- Initiates disease-specific care conferencing as needed.
- Utilizes patient communication strategies, e.g. motivational interviewing, to involve the patient in developing a plan of care, goals or other specific measures pertinent to their health condition.
- Assesses patient activation and readiness for change and uses these to develop self-management goals.
- Documents all disease management encounters using standardized processes.
- Utilization Management
- Possesses analytical skills to assess various patient utilization measures, such as ED, Urgent Care and Hospital Visits.
- Oversees ED, Urgent Care and Hospital admission utilization rates.
- Collaborates with the Leadership team to develop a plan of action to maintain acceptable utilization rates.
- Works collaboratively with the MA, Community Health Worker or LPN Clinic Coordinator, to promote activities that support the overall goals of the organization related to caring for different populations of patients.
- Engages the back office team and partners with leadership to support the population, disease and utilization management process goals and initiatives.
- Effectively communicates with staff members and providers. Can role model excellent communication skills.
- Works collaboratively with the leadership team to ensure that the staff comprehend and are compliant with the policies and procedures that relate to population, disease and utilization management.
- Monitors monthly quality measures, looks for trends and makes plans for improvements. Identifies problem areas for monitoring and evaluation and is active in analyzing findings, changing practice based on the findings. Works with the Quality Manager on process and informs staff of trends and areas where improvement is needed.
- Serves as an educational resource and provides consultation to other staff on utilizing evidence based criteria to maintain quality measures.
- Participates, as a Clinic Team Member, in Quality Improvement Projects and Initiatives.
- Perform other 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.
- Graduate of an accredited school of nursing
- Active Registered Nurse license through the Oregon State Board of Nursing
- Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)
- 3+ years of experience as a licensed, registered nurse, with recent clinical experience
- Knowledge of community resources
- Current Oregon driver license in good standing and reliable and insured transportation
- Full COVID-19 vaccination is an essential requirement of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
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