Case Manager RN – Remote in New Hampshire or Maine

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

 

We’re making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that’s driving the health care industry forward. 
This is a field-based position traveling to physician practices. Case managers review charts (paper and electronic – EMR), look for gaps in care, perform assessments, help coordinate doctor appointments, make follow-up calls to members after appointments, and assist our members in overall wellness and prevention. Case managers primarily work at physician practices on a daily basis.

 

If you are located in New Hampshire or Maine, you will have the flexibility to work remotely* as you take on some tough challenges.

 

Primary Responsibilities:

• Provides care coordination/case management through physician practices for members to improve clinical quality and clinical documentation
• May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols
• May interact with patients via telephone; Schedule appointments, follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed
• Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice
• Partner with the practice’s administrative and clinical staff while managing patient appointments and data between visits
• Create and maintain a professional and supportive relationship with the patient, provider, and office staff  
• Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services
• Assists the member to access community, Medicare, family, and other third-party resources as appropriate
• Collaborates and communicates with the member’s health care and service with our interdisciplinary delivery team to coordinate the care needs for the member
• Provides education to members regarding health care needs and available services
• Works to facilitate member compliance with their care / treatment plan and to ensure continuity of care
• Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address
• Documents all care coordination activities and interventions in the member’s health plan clinical record
• Maintains a focus on timely, high-quality customer service
• Maintains the confidentiality of all sensitive information

 

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:

• Current, unrestricted RN license in the State of ME or NH
• 3+ years of clinical experience in a hospital, acute care, home health, direct care or case management
• Demonstrated ability to identify with a consumer in order to understand and align with their needs and realities
• Demonstrated ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect
• Demonstrated ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s)
• Demonstrated ability to turn situations around and go above and beyond to meet the needs of the customer
• Computer/typing proficiency to enter/ retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications including MS Office and Excel
• Ability to travel in the range of 75% to provider offices within the service area of ME or NH – may be required up to one hour radius for travel 
• Access to reliable transportation, valid and unrestricted driver’s license, proof of insurance and ability to travel to provider offices or other locations within service delivery area
• Reside in either Maine or New Hampshire

 

Preferred Qualifications:

• Bachelor of Science in Nursing
• Case Management experience including Certification in Case Management
• Experience with HEDIS and EMR (electronic medical records)
• Experience with navigating and analyzing reports in Microsoft Excel
• Medicaid, Medicare, Managed Care experience
• Physician Office experience
• Call Center experience 
• Experience in intensive care (ICU), emergency department (ER) nursing, or Home Health
• Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
• Home care / field-based case management
• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 

The salary range for this role is $59,500 to $116,600 annually 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. 

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.

 

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. 

 

 

UnitedHealth Group 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.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.