Case Manager RN - Remote

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The Care Manager - Registered Nurse provides ongoing support and expertise through comprehensive assessment, planning, implementation, and overall evaluation of individual member needs. The goal of this position is to enhance the quality of member management and satisfaction, to promote continuity of care and cost effectiveness through the integration and functions of care management and discharge planning. It is the purpose of the Care Manager - Registered Nurse to ensure that the psychosocial and educational needs of the members are met. This position assists members and their families/significant others in making appropriate choices regarding the use of health care services. Care management services may be provided telephonically, in a provider office, or at member’s home.

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

Primary Responsibilities

• Develop a comprehensive care management plan that will address member’s individual needs which includes specific objectives, goals, and actions
• Prioritizes member care needs upon initial interaction/assessment and addresses emerging issues
• Assist members in the management of illness and treatment, monitoring adherence, and proactively investigating and addressing problems that may contribute to non- adherence with the member and other members of the multidisciplinary team
• Assesses reports, data, and other health plan information to identify potential members in need of care management intervention
• Decrease healthcare costs of members by working collaboratively care to assist members in managing visits to primary care, to decrease ER Utilization, number of inpatient hospitalizations, readmits to hospital, admissions to skilled nursing facilities and home health
• Monitor the effectiveness of the care management plan and short/long term goals and adjust per member need
• Assesses and prioritizes care referrals to assure program requirements for outreach and engagement are within expected time frames
• Provides member and family education, support, and encouragement, especially to enhance adherence to treatment regimen and follow up care
• Develops communication protocols with physicians in the network, clinic, and community so that early notification and intervention by the care management team occurs for members
• Independently keeps current on areas of care management, quality management, utilization management, member education and preventive health guidelines
• Provides recommendations in the development of policies and procedures that meet the requirements of NCQA, HEDIS, and State and Federal guidelines
• Acts as liaison and member advocate with other care providers and programs
• Participate in team meetings, multi-disciplinary meetings, care conferences and other collaboration via appropriate communication methods (teleconference, video conference, in-person conference)
• Integrates, coordinates and advocates for complex mental and physical health care services from a variety of health care providers and settings, within the framework of planned health outcomes
• Develops an effective support system within the family and community to manage emergency situations and to provide support and safety for the member
• Acts to prevent suicide and homicide in accordance with state licensure requirements
• Supports collection of information and other statistical data relevant to care loads, productivity and health care trends within member population
• Performs additional duties as assigned
  
  

The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.

Professional Competencies

• Working knowledge of health care delivery systems
• Working knowledge of PC applications including MS Office Suite and other supportive technology
• Ability to use written and oral communication skills
• Ability to read and interpret data
• Skill in writing clear, grammatically correct, easy to use instructional documentation
• Ability to identify learning needs, set goals and seek educational opportunities
• Ability to analyze problems and formulate appropriate plans, solutions, and courses of action
• Knowledge of age specific communication needs with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally
• Ability to work with frequent interruptions
• Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates
• Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners
• Ability to manage detail and work with accuracy
• Ability to recognize and act appropriately in situations where patient care needs exceed scope of practice
• Skill in working with a team and the ability to collaborate on projects with colleagues
• Skill in working effectively under deadlines and changing priorities
• Ability to effectively delegate action items appropriately to clinical and non-clinical staff in accordance with their role and scope of practice
  
  

Skills

• All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous, and respectful manner toward fellow employees, physicians, and patients.
• Must hold relationships to a high standard- respectful approach to all people and interactions, listening to understand, take emotional accountability and exemplify balance of self with all interactions, be receptive to feedback and opportunities keeping an open mind towards growth.
• Integrates Lean principles, practices, and tools to improve operational efficiency, reduce costs and increase customer satisfaction
• Follows written and oral instructions and completes routine tasks independently
• Completes annual compliance training on HIPAA/Privacy/Confidentiality/Non- Discrimination/Harassment/Integrity Statement and signs Agreements
• Ensures confidentiality of patient information following HIPAA guidelines and company policies
• Attends training to meet requirements of the job position and as needed or mandated by company policies and regulations
• Has regular and predictable attendance
  
  

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

• Degree in Nursing from an accredited school of nursing
• Unrestricted RN licensure
• CCM Certification within two years of employment
  
  

Preferred Qualifications

• Bachelor’s Degree
• 2+ years of clinical experience in a health care setting, care management for a health insurer
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
  
  

The hourly range for this role is $28.61 to $56.06 per hour 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.

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.