RN Complex Case Manager – Remote on PST

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.

 

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member’s health, social determinants, and gaps in care
• Creates and implements a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient’s needs and goals
• Performs ongoing updates of the care plan to evaluate effectiveness, and to document barriers, interventions, and goal achievement
• Partners with primary providers or multidisciplinary team members to align or integrate goals to plan of care
• Completes telephonic visits for member engagement and enrollment
• Uses motivational interviewing to evaluate, educate, support, and motivate change during member contacts
• Identifies and considers appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
• Ensures compliance with quality metrics specific to health plan delegation and accrediting body requirements 
• Conducts self and peer audits on a regular and assigned timeline
• Maintains caseload per defined medical management department standards
• Sustains productivity and audit requirements per medical management department standards
• Demonstrates ability to work independently and implement innovative approaches to complex member situations
• Determines need for continued member management, creates care plan and facilitates transition to medical management programs
• Attends departmental meetings and provides constructive recommendations for process improvement
• Performs other duties as assigned

 

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:

• Associates Degree in Nursing
• Valid multi-state compact license
• Case Management Certification or ability to obtain within 2 years of hire
• 2+ years of job-related experience in a healthcare environment
• Experience utilizing excellent communication, interpersonal, organization and customer service skills
• Knowledge of computer functionality and software applications (e.g., navigating systems, troubleshooting, electronic charting, accessing intranet and record management databases)
• Demonstrated knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, commercial) or regulatory bodies (e.g., NCQA)
• Understanding of relevant health care benefit plans
• Ability to work in Pacific Standard Time 

 

Preferred Qualifications:

• Bachelor’s degree or higher in healthcare related field
• 3+ years of experience providing case management and/or utilization review functions within health plan or integrated system
• Proven self-motivated, attention to detail

 

*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 salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

 

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.