Telephonic RN Case Manager, Care at Home - Washington and Colorado

UnitedHealth Group•Denver, CO

9h•$60,200 - $107,400•Remote

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 in an interdisciplinary care environment, 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. The Optum Care at Home program provides ongoing support for Dual Eligible Special Needs Plan (D-SNP) members with Medicare and Medicaid benefits. Through individualized care planning and targeted interventions, the program helps address complex clinical, behavioral, functional, and social needs while supporting members in their preferred care setting. As a Telephonic RN Case Manager, you will serve as a primary point of contact for members with complex medical, behavioral health, functional, social, and long-term services and supports needs. You will conduct telephonic assessments, develop person-centered care plans, coordinate transitions and community-based services, resolve barriers to care, and support members in remaining safely in their preferred setting whenever possible. This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes.

Requirements

Active, unrestricted RN license or multistate RN license with legal authority to practice for members located in both Washington and Colorado by the position start date
2+ years of professional RN experience
Experience coordinating care for patients or members with complex or high-risk medical, behavioral health, functional, or social needs
Experience with Medicaid Long-Term Services and Supports (LTSS), Home- And Community-Based Services, or a closely related Medicaid care management program
Experience in case management, managed care, community health, home health, ambulatory care, population health, transitions of care, or another setting involving longitudinal care coordination
Proficiency documenting in electronic health records or care management platforms and navigating multiple computer applications while speaking with members by phone
Driver’s License and access to reliable transportation

Nice To Haves

Certified Case Manager (CCM) certification or another relevant case management credential
Knowledge of Washington or Colorado Medicaid programs, health care systems, and community organizations serving older adults, people with disabilities, and individuals with complex needs
Experience coordinating long-term care, personal care services, private duty nursing, home health, or other home- and community-based services
Experience with utilization management, utilization review, discharge planning, concurrent review, or risk management
Experience working effectively with interdisciplinary teams in a remote or telephonic care management environment
Reside in Washington or Colorado

Responsibilities

Conduct comprehensive telephonic assessments of members’ medical, behavioral health, functional, psychosocial, caregiver, environmental, and socioeconomic needs
Develop, implement, and reassess individualized, person-centered care plans that reflect each member’s goals, preferences, risks, strengths, and desired level of independence
Coordinate care across Medicare, Medicaid, primary and specialty care, behavioral health, pharmacy, home health, long-term services and supports, and community-based programs
Identify gaps in care and barriers to treatment, including transportation, food insecurity, housing instability, caregiver needs, financial concerns, medication access, and health literacy, and connect members with appropriate resources
Facilitate safe transitions between hospitals, skilled nursing facilities, rehabilitation settings, home health, and the member’s residence, including timely follow-up with members, caregivers, and treating providers
Assess changes in condition, apply clinical judgment and approved escalation pathways, and partner with assigned care managers, utilization management, market leadership, and clinical teams to address urgent or complex needs
Respond to and support resolution of member escalations involving state Medicaid agencies, health care authorities, managed care organizations, health systems, members, families, caregivers, and other stakeholders
Provide education on conditions, medications, warning signs, self-management, preventive care, and available benefits while using clear, culturally responsive, member-centered communication
Advocate for members and caregivers so their needs, choices, rights, and preferences are represented in care planning and service delivery
Support advance care planning discussions and connect members with appropriate clinical or community resources consistent with program guidelines
Document assessments, care plans, interventions, referrals, outreach attempts, outcomes, and required data accurately and promptly in designated electronic health record and care management systems
Use evidence-based practice standards, medical necessity criteria, and applicable Medicare, Medicaid, contractual, legal, and regulatory requirements when coordinating services
Maintain required RN licensure, continuing education, and role-related credentials