RN Complex Case Manager - Remote

UnitedHealth Group•Fishkill, NY

2d•$29 - $52•Remote

About The Position

Optum NY is seeking an RN Case Manager to join their team anywhere within the U.S. Optum is a clinician-led care organization focused on improving how clinicians work and live. As a member of the Optum Care Delivery team, you will contribute to the vision of making healthcare better for everyone. Optum provides the clinical resources, data, and support of a global organization to help patients live healthier lives. The company believes in empowering employees to have exceptional careers and live their best lives at work and at home. This role offers the fulfillment of advancing community health with the excitement of contributing new practice ideas and initiatives that could improve care for millions of patients nationwide. 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. Employees will enjoy the flexibility to work remotely from anywhere within the U.S.

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 the 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
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Candidates are required to pass a drug test before beginning employment.

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