Senior Case Manager RN - AL

UnitedHealth Group•Mobile, AL

21h

About The Position

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere. As a team member of our Optum Care at Home team, together with an interdisciplinary care team we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. As a Senior Case Manager in our Atlanta office, you will assist with escalated cases and internal / external vendor interface, participate in customer calls and meetings as required; coach staff on team, complete quality case and call audits; conduct phone calls to consumers if needed to achieve the team outreach goals or coverage for case managers. Must be interested in career path as a Clinical Manager. Position will also review patient status over the phone while ensuring they are receiving the best care.

Requirements

Current, unrestricted RN license in the State of Alabama
Willingness and ability to obtain additional licensures as needed
Ability to obtain CCM within 24 months of assuming role
3+ years of RN experience in a hospital setting, acute care, direct care experience
1+ years of leadership background experience
1+ years of experience as a Case Manager in a managed care setting
Computer proficiency, to include solid data entry skills and the ability to navigate a Windows environment
Driver’s License and access to reliable transportation

Nice To Haves

BSN or Master’s degree
Background in managed care
Disease management experience
Experience / exposure with discharge planning
Medical / Surgical, Home Health, Diabetes or Cardiac experience (certification in one of those specialties)
Bilingual (Spanish / English) skills

Responsibilities

Serve as a mentor and coach to staff case managers
Handle escalated cases from team
Interact directly with vendors and account management
Make outbound calls to assess members' current health status
Identify gaps or barriers in treatment plans
Provide patient education to assist with self-management
Interact with Medical Directors on challenging cases
Coordinate care for members
Make referrals to outside sources
Coordinate services as needed (home health, DME, etc.)
Educate members on disease processes
Encourage members to make healthy lifestyle changes
Document and tracking findings
Make post-discharge calls to ensure that discharged member receive the necessary services and resources