RN Case Manager Remote
About The Position
Optum NY, is seeking a RN Case Manager to join our remote team. If you live within NY, CT or NJ and have an active NY RN License, you are eligible to apply. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. The RN Case Manager role, operating under general administrative direction, is primarily responsible for coordinating referrals from physicians and healthcare facilities for high-risk members. This position involves significant member education related to their illnesses and planned treatments. The Case Manager supports various Case Management and Quality Improvement programs, ensuring timely communication between members, providers, and health plans. Additionally, the role includes maintaining grievance files and associated documentation. The overarching goal of the Case Manager is to identify, coordinate, and provide appropriate levels of care while managing clinical operations and medical management activities across the continuum of care. This includes assessing, planning, implementing, coordinating, monitoring, and evaluating care. The role also encompasses health education, coaching, and treatment decision support for members, requiring a Registered Nurse (RN) qualification. The Case Manager plays a critical role in bridging the gap between healthcare providers, members, and health plans, ensuring that high-risk members receive comprehensive, coordinated, and high-quality care. The position requires strong clinical expertise, excellent communication skills, and a commitment to improving healthcare delivery. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.
Requirements
- Bachelor of Science in Nursing (BSN), or 5 years case management experience in lieu of BSN
- Unrestricted current RN licensure in state of New York
- 2+ years of experience in health plan case management, complex and disease case management
- Experience in a remote and telephonic role
- Proficient in Microsoft Office and Adobe products
- Ability to travel to home office as necessary for training, meetings, or as requested by Supervisor/Manager
Nice To Haves
- BSN
- Commission for Case Manager Certification (CCMC)
- Case Management experience
- Experience in discharge planning
- Experience in utilization review, concurrent review, or risk management
- A background in managed care
Responsibilities
- Member Care Coordination
- Collaborates with physicians and multidisciplinary teams to develop and maintain up to date, coordinated care plans
- Acts as a liaison between members and the healthcare team to ensure effective communication and alignment of care plans
- Member Referral Support
- Assists physicians, members, and families in obtaining referrals to specialists
- Provides counseling and support tailored to the clinical needs of the member
- Care Plan Development
- Partners with designated physicians to create and maintain individualized Member Care Plans
- Clinical Improvement
- Actively participates in developing and deploying Coordination of Care activities aimed at enhancing the clinical experience for both referred members and referring physicians
- Liaison Role
- Facilitates communication among care team members to address the needs of both the member and the physician
- Provider/Member Education
- Educates members and care team participants about available community and health plan benefits and services
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
