RN Case Manager - ED - Remote in UT

UnitedHealth Group•Draper, UT

4d•$72,800 - $130,000•Remote

About The Position

Optum UT is seeking a Registered Nurse Case Manager to provide telephonic, proactive case management to members with frequent Emergency Department utilization. The role focuses on reducing avoidable ED visits and hospital admissions through early intervention, care coordination, and member engagement. The RN Case Manager collaborates with providers, caregivers, community resources, and interdisciplinary teams to address clinical, behavioral, and social determinants of health and support members across the continuum of care. The position contributes to ED diversion and admission prevention efforts while improving health outcomes, member experience, and appropriate healthcare utilization. Candidates located in Utah may work remotely and must have an active, unrestricted Utah RN license. The role includes documenting care in accordance with organizational and regulatory requirements and supporting utilization management, quality improvement, HEDIS/HOS measures, patient satisfaction, and population health goals. The position offers development opportunities and a comprehensive benefits package, subject to eligibility requirements.

Requirements

Current, unrestricted Registered Nurse (RN) license in Utah.
At least 3 years of clinical nursing experience; acute care, care management, case management, utilization management, discharge planning, or transitional care experience is preferred within this requirement.
Experience in managed care, Medicare Advantage, value-based care, care management, or population health environments.
Case management knowledge and the ability to independently assess member needs, develop care plans, prioritize interventions, and manage complex cases with minimal supervision.
Strong clinical assessment, critical thinking, problem-solving, and decision-making skills.
Excellent written, verbal, and interpersonal communication skills.
Ability to collaborate effectively with providers, hospitals, skilled nursing facilities, Community Health Workers, and interdisciplinary care teams.
Proficiency with electronic medical records, case management systems, and Microsoft Office applications.

Nice To Haves

Bachelor’s degree in nursing (BSN).
Case Management Certification (CCM, ACM-RN, or equivalent).
Experience supporting transitions of care, readmission prevention, post-acute care management, or emergency department utilization programs.
Knowledge of community resources and social determinants of health.

Responsibilities

Provide RN case management support to identified high-risk and frequent ED utilizers in assigned markets.
Conduct comprehensive assessments of clinical, psychosocial, behavioral health, and social determinants of health needs.
Provide proactive outreach, care coordination, and ongoing member engagement to promote self-management and adherence to care plans.
Reinforce engagement with primary care providers and facilitate timely follow-up appointments.
Educate members and caregivers about disease management, symptom recognition, medication adherence, and appropriate care settings.
Identify and address root causes of ED utilization, including care gaps, access barriers, social needs, and behavioral health concerns.
Connect members with programs and services such as Complex Case Management, Disease Management, Behavioral Health, Social Work, and community resources.
Use ED diversion strategies to support treatment in the appropriate setting and prevent avoidable hospital admissions.
Monitor member progress and adjust interventions in response to changing healthcare needs and risk factors.
Document assessments, interventions, care plans, and outcomes in accordance with organizational and regulatory requirements.
Support goals related to utilization management, quality improvement, HEDIS/HOS measures, patient satisfaction, and population health outcomes.
Meet outreach, engagement, assessment, follow-up, care coordination, documentation, productivity, and quality performance expectations.
Collaborate with Community Health Workers, providers, and interdisciplinary teams to address barriers and improve care transitions.
Perform other duties as assigned.