Case Manager, LVN/LPN, Texas Licensed
Company: Optum
Location: Irving
Posted on: June 2, 2025
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Job Description:
Opportunities at WellMed, part of the Optum family of
businesses. We believe all patients are entitled to the highest
level of medical care. Here, you will join a team who shares your
passion for helping people achieve better health. With
opportunities for physicians, clinical staff and non-patient-facing
roles, you can make a difference with us as you -discover the
meaning -behind -Caring. Connecting. Growing together.------ -
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The Nurse Case Manager I (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. The Nurse Care Manager will
determine medical appropriateness of outpatient services following
evaluation of medical guidelines and benefit determination. The
Nurse Case Manager will coordinate, or provide appropriate levels
of care under the direct supervision of an RN 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. This role acts as a support to team members,
coaching, guiding and providing feedback as necessary. 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.
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-You'll enjoy the flexibility to work remotely * from anywhere
within the U.S. as you take on some tough challenges. Must Be Texas
Licensed and can work on the Central Time Zone, Monday - Friday,
8:00 AM - 5:00 PM CST
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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
With oversight of RN and/or MD, utilizing evidence-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
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
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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:
HS Diploma or GED
Current, unrestricted LPN/LVN license, specific to the state of
employment - Texas or Compact
2+ years of managed care and/or case management experience
2+ years of clinical experience
Knowledge of managed care, medical terminology, referral process,
claims and ICD-10 codes
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Preferred Qualifications:
Case Management certification
Knowledge of utilization management and/or insurance review
processes as well as current standards of care, a solid knowledge
of health care delivery systems and the ability to interact with
medical directors, physician advisors, clinicians and support
staff
Proficient computer skills in Microsoft applications and Microsoft
Excel
Proven skills in planning, organizing, conflict resolution,
negotiation and interpersonal skills to work with autonomy in
meeting case management goals and initiatives
Proven ability to work independently in accomplishing assignments,
program goals and objectives
Proven excellent written and verbal skills
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*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy -
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The hourly range for this role is $19.86 to $38.85 per hour based
on full-time employment. Pay is based on several factors including
but not limited to local labor markets, education, work experience,
certifications, etc. UnitedHealth Group complies with all minimum
wage laws as applicable. In addition to your salary, UnitedHealth
Group offers 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
UnitedHealth Group, you'll find a far-reaching choice of benefits
and incentives.
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Application Deadline: This will be posted for a minimum of 2
business days or until a sufficient candidate pool has been
collected. Job posting may come down early due to volume of
applicants.
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At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission. - -
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Diversity creates a healthier atmosphere: UnitedHealth Group is an
Equal Employment Opportunity/Affirmative Action employer 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. -
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UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment. -
Keywords: Optum, McKinney , Case Manager, LVN/LPN, Texas Licensed, Healthcare , Irving, Texas
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