Experienced RN Complex Case Manager (NY RN License Required)
About The Position
Optum NY is seeking an RN Case Manager to join their team, offering remote work flexibility from anywhere within the U.S. This role is part of the Optum Care Delivery team, focused on improving healthcare for everyone. The RN Case Manager will coordinate referrals for high-risk members, educate them on their illnesses and treatments, and support Case Management and Quality Improvement programs. They will ensure communication between members, providers, and health plans, and maintain grievance files. The overarching goal is to identify, coordinate, and provide appropriate care across the continuum, involving assessment, planning, implementation, coordination, monitoring, and evaluation. Health education, coaching, and treatment decision support are key components, requiring a Registered Nurse (RN) qualification. The position bridges the gap between healthcare providers, members, and health plans, ensuring high-risk members receive comprehensive, coordinated, and high-quality care. This requires strong clinical expertise, excellent communication skills, and a commitment to improving healthcare delivery.
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
- 3+ years of diverse clinical experience as a Registered Nurse; preferably in caring for acutely ill members with multiple disease conditions
- 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
Nice To Haves
- BSN
- Commission for Case Manager Certification (CCMC)
- Experience in discharge planning
- Experience in utilization review, concurrent review, or risk management
- Background in managed care
Responsibilities
- 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
- Assists physicians, members, and families in obtaining referrals to specialists
- Provides counseling and support tailored to the clinical needs of the member
- Partners with designated physicians to create and maintain individualized Member Care Plans
- Actively participates in developing and deploying Coordination of Care activities aimed at enhancing the clinical experience for both referred members and referring physicians
- Facilitates communication among care team members to address the needs of both the member and the physician
- Educates members and care team participants about available community and health plan benefits and services
Benefits
- 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
