LVN/LPN CM/UM Unplanned Inpatient Admission Review UIAR

Company: Optum
Location: Gonzales
Posted on: June 24, 2025

Job Description:

WellMed, part of the Optum family of businesses, is seeking a Licensed Vocational Nurse LVN or LPN CM or UM Unplanned Inpatient Admission Review - UIAR to join our team in Texas. 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 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. If you are located within the San Antonio, TX area and have a Compact license, you will have the flexibility to work remotely* as you take on some tough challenges. 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 In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000 primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000 older adults. Together, we're making health care work better for everyone. 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 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 *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy 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 hourly pay for this role will range from $20.00 to $35.72 per hour 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.

Keywords: Optum, Georgetown , LVN/LPN CM/UM Unplanned Inpatient Admission Review UIAR, Healthcare , Gonzales, Texas