Case Manager - Registered Nurse - Remote
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. 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 the members' 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 members' individual needs which include specific objectives, goals, and actions Prioritizes member care needs upon initial interaction/assessment and address emerging issues Assist members in the management of illness and treatment, monitor adherence, and proactively investigate and address problems that may contribute to non-adherence with the members 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 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 members 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 Develop an effective support system within the family and community to manage emergency situations and to provide support and safety for the members 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 Potential for RN oversight of LNP/LVN. Provide clinical supervision and direction to LPN/LVN staff in accordance with state scope of practice and organizational policies Maintain overall accountability for member care outcomes delivered by LPN/LVN Review and validate care plans developed or supported by LPN/LVN staff Provide real-time guidance, coaching and clinical support to LPN/LVN staff Performs additional duties as assigned 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 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 CA license CCM Certification within three years of employment Preferred Qualifications: Bachelor's Degree 2 years of clinical experience in a health care setting, care management for a health insurer 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, listen 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, 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 the requirements of the job position and as needed or mandated by company policies and regulations Has regular and predictable attendance *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 $60,200 - $107,400 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. 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.
