LVN Care Advocate Well Med
UnitedHealth Group
- San Antonio, TX
- Permanent
- Full-time
- 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
- Licensed Practical/Vocational Nurse
- Current, unrestricted LPN/LVN license specific to the state of employment
- 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
- Proven excellent verbal and written skills
- 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
- 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
- Demonstrated 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
- Ability to properly drive and operate a company vehicle