Senior RN Case Manager - Remote

UnitedHealth Group•Fishkill, NY

21h•Remote

About The Position

Optum NY/NJ is seeking a Senior RN Case Manager to join their team. Optum is a clinician-led care organization focused on improving healthcare delivery. As part of the Optum Care Delivery team, the role contributes to making healthcare better for everyone by providing clinical resources, data, and support. The position offers the fulfillment of advancing community health and the opportunity to contribute new practice ideas. The function is responsible for clinical operations and medical management activities across the continuum of care, including case management, care coordination, medical management consulting, health education, coaching, and treatment decision support. This role coordinates, supervises, and is accountable for the daily activities of business support, technical, or production teams. The impact of the work is primarily at the local level. The role offers the flexibility to work remotely from anywhere within the U.S. For hires in the Minneapolis or Washington, D.C. area, a minimum of four days per week in the office is required.

Requirements

Current, unrestricted RN license in both New York and New Jersey
Bachelor of Science in Nursing (BSN)
Associate of Science in Nursing
5+ years of diverse clinical experience; preferred in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management
2+ years of diverse clinical experience, preferably in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management
Proven expert knowledge of case management principles, as evidenced by certification in Case Management (CCM) or willing to obtain within 12 months of employment
Proven knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, InterQual)
People-management experience, to include motivational leadership, ability to implement performance improvement plans, and a drive to see employees succeed in their work
Experience managing direct reports to performance metrics
Proficient with Microsoft Office applications including Word, Excel, and PowerPoint, and Adobe products
Remote work experience

Nice To Haves

5+ years of managed care (delegated medical management), Complex Case Management,
1+ years of recent leadership experience (manager, supervisor, team lead, etc.), with ability to partner with staff to build high-performing teams
Disease Management and Transitional Case Management experience
Knowledge of utilization management, quality improvement, and discharge planning
Ability to cultivate a solid internal culture designed around collaboration, feedback, motivation, and accountability
Solid communication and interpersonal skills
Demonstrated ability to work in a fast pace, multi-tasking team environment while meeting deadlines
Highly skilled in leading change efforts and in building solid partnerships with business-line executives
Ability to summarize complex issues and problems into a concise report focused on key findings and outcomes
Ability to consistently manage up and down
Ability to complete initiatives with minimal supervision
Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives
Demonstrated sophisticated written and verbal presentation abilities; experience with the development of presentation materials (collateral, proposals, presentations, talking points, etc.)
Proven proficiency in the management of time, flexibility, and influencing colleagues to meet demanding project/requested timelines

Responsibilities

Maintain caseload
Reviews the work of others
Develops innovative approaches
Coordinates work activities with supervisors and/or managers
Serve as a clinical resource and coach for Complex Case, Disease and Transitional Case Management programs, and ED Follow-up
Act as primary preceptor for RN and LPN Case Managers
Assign and support preceptor for all other roles
Support and maintenance of relationships with affordability and vendor programs, including palliative care, continuum/fee for services programs, and patient care conferences
Anticipates customer needs and proactively develops solutions to meet them
Serves as a key resource on complex and/or critical issues
Solves complex problems and develops innovative solutions
Performs complex conceptual analyses
Reviews work performed by others and provides recommendations for improvement
Forecasts and plans resource requirements
Authorizes deviations from standards
May lead functional or segment teams or projects
Provides explanations and information to others on the most complex issues
Motivates and inspires other team members
Conduct call monitoring and case auditing of staff and implementing performance improvement plans
Ability to work in a fast-paced environment
Facilitate the complaint process by engaging member, family, and caregivers telephonically
Establish a process for member education to assist with self-management goals, disease management or acute condition
Utilize evidenced-based practice to develop interventions
Establish a process to utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
Manage the quality of clinical assessments and Care Plans
Coordinate regular clinical reviews of high-risk cases with members of the Interdisciplinary Care Team (IDCT)
Ensure adherence to relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, InterQual) for Complex Case, Disease and Transitional case management
Demonstrate understanding of utilization management processes
Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
Monitor staff caseload in an efficient and effective manner to ensure optimal productivity
Monitor and ensure timely and accurate documentation in the care management electronic software system to comply with documentation requirements and achieve individual and collective audit scores of 95%25 or better monthly
Attends meetings and participates on committees as requested
Identifies opportunities for process improvement in all aspects of member care
Supports data collection and closing of care gaps and quality metrics as assigned and assists the healthcare team in meeting quality metrics
Must always maintain strict confidentiality
Must adhere to all department/organizational policies and procedures
Performs all other related duties as assigned