Telephonic Case Manager LPN - Houston, TX
UnitedHealth Group - Houston, TX

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Position Description:

The primary purpose is to deliver telephonically support service coordination, community resource integration, and psychosocial support in coordination with behavioral health services. This results in consistent, collaborative and coordinated care based on member needs and risk profile. Identifying member needs begins with early identification of health risk factors, as identified by the member and consult to collaborate with the Health Services Manager and Interdisciplinary Team to conduct planning, invention, evaluation, education and prevention using the plan of care.

Primary Responsibilities:

· Responds with appropriate coordination of care and services protocol by level of care assignment.

· Completes telephonic risk stratification assessment if in communication with member who has not had a risk stratification assessment completed

· Contacts member to explain care management process and completes a welcome call assessment on new members

· Shares input into the plan of care with appropriate members of the care team so care team members are working towards uniform member goals Utilizes motivational interviewing techniques to obtain member information including: family, caregivers, providers reporting etc.

· Identifies formal and informal resources to meet the member needs as stated in the plan of care

· Enters service notifications/authorizations according to guidelines

· Communicates with the member, primary care physician and community partners concerning service and behavioral health needs and alternatives to providing services to meet the needs

· Serves as member advocate and facilitator to resolve issues that may be barriers to care

· Through developing a relationship with the member /family, the care manager educates the member /family about their behavioral health conditions, socialization options, treatment options, community resources, insurance benefits and so that informed decisions can be made and member self-management is promoted

· The Service Coordinator completes delegated activities from the Health Services Manager as appropriate surrounding the provision of information related to health conditions and treatment options as a part of the plan of care

· Ensures appropriate utilization and consistent application of the benefits and applies benefits coordination knowledge

· Maintains time sensitive documentation including case management/service coordination interventions and outcomes to assure compliance with program goals and regulatory agencies

· Organizes work and develops strategies for adapting to a constantly changing workload or when confronted with unseen situations

· Using defined tools and/or collaborating with the Health Services Manager, the Service Coordinator facilitates early identification of changes in condition so that effective treatment can be initiated promptly, reducing the need for preventable emergency room visits, nursing home placements and hospitalizations

· Provides care management services for psychosocial, functional and financial needs in the community, including on-site and telephonic reassessments according to protocol.

· Monitors member responses to the interventions and adjusts plan of care as needed.

· In collaboration with the Inpatient Care Manager, the Service Coordinator monitors hospital and SNF admissions according to post hospital program and provides education and/or post hospitalization follow-up/interventions as necessary to reduce frequency

· Participates in the Quality Improvement process including the recognition of quality of care issues and forwarding information to appropriate staff for review and resolution.

Requirements:
  • High School Diploma or GED is required.
  • LPN or LVN with current Texas State license or license Social Worker is required.
  • 3+ years clinical experience working as an LPN or Social Worker is required.
  • Intermediate MS/Office (Word, Excel & Outlook) is required.
  • Long term care experience preferred, case management in a clinical setting (hospital, long term care) or managed care experience in a care coordination role also preferred
  • Ability to utilized and function within multiple software programs; toggle between systems effectively.
  • Experienced in meeting the needs of vulnerable populations who have Chronic or Complex Conditions is preferred.
Assets:
  • Long term care experience preferred case management in a clinical setting (hospital, long term care) or managed care experience in a care coordination role also preferred.
UnitedHealthcare Community & State is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you're ready to help make health care work better for more people, you can make a historic impact on the future of health care at UnitedHealthcare Community & State.

We contract with states and other government agencies to provide care for over two million individuals. Working with physicians and other care providers, we ensure that our members obtain the care they need with a coordinated approach.

This enables us to break down barriers, which makes health care easier for our customers to manage. That takes a lot of time. It takes a lot of good ideas. Most of all - it takes an entire team of talent. Individuals with the tenacity and the dedication to make things work better for millions of people all over our country.

You can be a part of this team. You can put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

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