Universal American

Care Manager - LVN/LSW

Job Title: Care Manager - LVN/LSW

Job ID: 816204

Begin Date: 8/18/14

Duration

Location: Houston, TX

Other Location

Description: Universal American is a New York Stock Exchange company with annual revenues of more than $2 billion. Through our family of healthcare companies, we provide health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs.

Well-capitalized and highly entrepreneurial, Universal American has been on the cutting edge of healthcare for more than 21 years. We offer Medicare Advantage plans to people with Medicare. We partner with providers in Accountable Care Organizations that serve people with Original Medicare. And we provide array of healthcare services to states, municipalities, health plans and other entities in the world of Medicaid. In everything we do, we focus on improving the coordination of healthcare through collaboration between payers, providers and patients to achieve the best health outcomes possible.

For more information on Universal American, please visit our website at www.UniversalAmerican.com.

Job Description
As the Case Manager you will be responsible for coordinating and developing care plans for members through intake, risk assessment, and monitoring. This individual will facilitate pre-certification, concurrent review, discharge planning and case management as assigned. The Case Manager will be responsible for efficient utilization of health services and optimal health outcomes for members, as well as meeting designated metrics.

Responsibilities:
Provides case management services for assigned case load of members, including:
•Screening - Engages member to conduct intake and provide risk identification
•Assessment - Identifies medical, psychological and social issues that need intervention
•Coordination - Partners with member, family, PCP and other providers to coordinate services
•Care Planning – Creates care plan and sets goals for problem resolution
•Monitoring – Monitors progress of care plan for closure of gaps in care and accomplishment of goals. Determines if care plan needs additions or modifications. Provides education about disease states and access to educational self-management classes.
•Creates and maintains documentation meeting health plan standards of all case management activities
•May be required to perform service authorization duties using prescribed criteria and responsibilities and established medical review guidelines as assigned and required by the Plan.
•Precertification - complete intake, data entry and pre-authorization of service requests, including PCA and home care services
•Concurrent Review - telephonic review of medical necessity for elective admission and identification and referral when necessary for discharge planning
•Discharge Planning - responsible for arrangement and authorization (where applicable) of needed health care services including but not limited to specialty referrals, PCP appointments, home care, community based resources and DME and follow members through transitions and post discharge
•Meets regularly with medical director for case reviews and appropriately refers to medical director as applicable for questionable health care services
•Monitors assigned case load and seeks to attain goal achievement at the member level and case load level
•Refers out of network providers to Provider Relations for rate negotiations and service agreements where applicable
•Perform on site or home assessment of members living conditions as assigned. May be required to meet or accompany member to appointments.
•Fosters a team approach within the Case Management Department
•Meets performance metric requirements as part of annual performance appraisals
•Utilizes ICD9-CM and CPT codes for data entry into UM/CM system
•Familiar and compliant with regulatory care management requirements for each program under management
•Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable, and defined in the Universal American Corporate and department policies.

Required Skills
•Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
•Organizational skills with the ability to handle multiple tasks and/or projects at one time
•Customer service skills with the ability to interact professionally and effectively with providers, third party payers, physicians, and staff from all departments within and outside the Company
•Analytical and interpretation skills including departmental, utilization, financial and operations data
•Decision-making skills with the ability to investigate and weigh alternatives and select the course of action that provides the greatest benefit to the organization
•Creative thinking skills with the ability to ask the needed bigger-picture questions that lead to process and team improvements
•Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
•Problem solving skills with the ability to look for root causes and implementable, workable solutions and to ensure the member's plan of care is addressed and followed and that issues are escalated appropriately
•Interpersonal skills with the ability to work in a fast-paced environment and participate as an independent contributor with little supervision or as an active team member depending on the situation and needs
•Must have a track record of producing work that is highly accurate, demonstrates attention to detail, and reflects well on the organization

Required Experience
•Associates’ degree in Nursing and TX RN License with 1 year clinical experience OR Master's Degree in Social Work and LCSW or LMSW license with 1 year clinical experience.
•Understanding of how healthcare services impact costs and the ability to identify services that will result in the best quality outcomes of their members
•Certified Case Manager certification preferred
•Personal computer experience should include working with Microsoft Word, Excel, PowerPoint and Outlook at the intermediate level at a minimum

Universal American Corp. is an Equal Opportunity / Affirmative Action Employer and does not discriminate because of age, color, disability, ethnicity, marital or family status, national origin, race, religion, sex, sexual orientation, military veteran status, or any other characteristic protected by law. We are committed to attracting, retaining and maximizing the performance of a diverse and inclusive workforce.

Required Skills: Care Manager - LVN/LSW

Openings: 1

Care Manager - LVN/LSW

Option 1: Create a New Profile

Option 2: Login and Apply