Hybrid Nurse Case Manager in Lee or Collier County

This is a Hybrid Role- 50% onsite in facilities and 50% working remote from home

WellMed, part of the Optum family of businesses, is seeking a Nurse Care Manager II to join our team in Fort Myers, FL. 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 Nurse Case Manager II (NCM) is responsible for patient case management for longitudinal engagement, coordination for discharge planning, transition of care needs and outpatient patient management through the care continuum. Nurse Case Manager will identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a patients' action plan and/or discharge plan. They will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. The Nurse Case Manager will provide continuity of care for members to an appropriate lower level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The Nurse Case Manager will coordinate, or provide appropriate levels of care under the direct supervision of an RN Manager or MD. Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for patients. The Nurse Case Manager will act as an advocate for patients and their families guide them through the health care system for transition planning and longitudinal care. The Nurse Case Manager will work in partnership with an assigned Care Advocate and Social Worker.

Primary Responsibilities:

• Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health status
• Provide member education to assist with self-management goals; disease management or acute condition and provide indicated contingency plan
• Identify patient needs, close health care gaps, develop action plan and prioritize goals
• Utilizing evidenced-based practice, develop interventions while considering member barriers independently
• Provide patients with "welcome home" calls to ensure that discharged patients' receive the necessary services and resources according to transition plan
• Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care
• Independently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria within our documentation system for discharge planning and/or next site of care needs
• In partnership with care team triad, make referrals to community sources and programs identified for patients
• Utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
• Manages assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers
• Collaborates effectively with Interdisciplinary Care Team (IDCT) to establish an individualized transition plan and/or action plan for patients
• Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in departmental huddles
• Demonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning activities
• Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
• Manage assigned caseload in an efficient and effective manner utilizing time management skills
• Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 95% or better on a monthly basis
• Maintain current licensure to work in state of employment and maintain hospital credentialing as indicated
• 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.

Required Qualifications:

• Associate's degree in Nursing
• Current, unrestricted RN license required, 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; preferred in caring for the acutely ill patients with multiple disease conditions
• 3+ years of managed care and/or case management experience
• Knowledge of utilization management, quality improvement, and discharge planning
• Reliable transportation and maintain an active driver's license
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease

Preferred Qualifications:

• Experience working with psychiatric and geriatric patient populations
• Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel
• Bilingual (English/Spanish) language proficiency
• Proven ability to read, analyze and interpret information in medical records, and health plan documents
• Proven ability to problem solve and identify community resources
• Proven to possess planning, organizing, conflict resolution, negotiating and interpersonal skills
• Proven ability to independently utilizes critical thinking skills, nursing judgement and decision-making skills. Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously

Physical & Mental Requirements:

• Ability to lift up to 10 pounds
• Ability to push or pull heavy objects using up to 25 pounds of force
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other 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 beginning employment.