Complex RN Case Manager, Advantage Plus Network of CT

Opportunities with Advantage Plus Network of Connecticut, part of the Optum family of businesses. When you work at ProHealth Physicians, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind Caring. Connecting. Growing together. 

Position Details:

• Location: Telecommuter position, but must be able to independently travel to Farmington, CT for training/meetings on an as needed basis
• Department: Case Management
• Schedule: Full time, 40 hours/weekly, Monday through Friday, 8:00AM – 4:30PM

Primary Responsibilities: 

• Member Care Coordination.  Works closely with physicians involved in member’s plan of care to coordinate care plan communication; works with multidisciplinary team to maintain and implement up-to-date coordinated care plan; communicates with all members of the healthcare team on behalf of the member
• Member Referral Support:  Assists physician providers, members, and their families in obtaining referrals to needed specialists.  Provides support and counseling, as appropriate to the clinical situation
• Care Plan Development.  Works with designated physicians to develop and maintain member care plans
• Clinical Improvement.  Proactively participates in the development and deployment of coordination of care activities with the goal of improving the clinical experience for referred members and the referring physician
• Liaison.  Communicates with members of the care team as appropriate to coordinate the identified member and physician’s needs
• Provider/Member Education.  Educate member and care team participants on community/health plan benefit services available
• Performs various duties as needed to successfully fulfill the function of the position in conjunction with Medical Management as needed

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:

• Bachelor’s Degree in Nursing (BSN)
• Unrestricted current CT Nursing License
• 2+ years of experience managing complex disease states
• 2+ years of telephonic health plan case management
• Experience with Electronic Health Records (Allscripts, Epic)
• Knowledge and understanding of NCQA/ACO/CDO regulations and standards
• High proficiency with navigating multiple complex computer programs (including but not limited to Microsoft Products, Adobe)
• Ability to travel up to independently Farmington, CT for training and meetings as needed. Possible travel to other locations at times

Preferred Qualifications:  

• Master’s Degree in Nursing (MSN)
• Certified Case Manager Certification (CCMC)
• 5+ years of experience as a nurse case manager
• 5+ years of experience managing complex disease states
• 2+ years of utilization management or concurrent review experience
• Experience in a remote work setting 
• Bilingual with English and Spanish, Polish, Mandarin, or Vietnamese 

The organization reserves the right to modify position responsibilities at any time, due to business necessity.

Connecticut Residents Only: The salary range for this role is $58,300 to $114,300 annually. 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.

ProHealth Physicians is Connecticut’s leading community-based medical group. Formed in 1997, we have primary care offices in every county. Our 300+ doctors and advance practice clinicians care for children and adults of all ages. We also have in-house imaging and clinical lab services. Traditional medicine treats people when they’re sick. Instead, we focus on preventing diseases. Our goal is to give our patients — and their communities — the tools they need to be and stay well. This is how we help people live healthier lives. Together, we’re making health care work better for everyone.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.