Telephonic RN Case Manager, Optum Care at Home - Remote in Washington

UnitedHealth Group•Seattle, WA

7h•$91,500 - $137,300•Remote

About The Position

Optum Care at Home, part of Optum Home & Community Care, 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 addresses complex clinical, behavioral, functional, and social needs while supporting members in their preferred care setting. The Telephonic RN Case Manager is a primary contact for members with complex medical, behavioral health, functional, social, and long-term services and supports needs. The role conducts telephonic assessments; creates person-centered care plans; coordinates transitions and community-based services; resolves barriers to care; and supports members in remaining safely in their preferred setting whenever possible. This is a high-volume, customer-service environment requiring efficient and thorough phone interactions, strong computer and software navigation skills, a patient-focused approach, and adaptability. The role works Monday through Friday during daytime business hours and must support operations across Mountain and Pacific Time Zones. The position covers Washington and Colorado markets and is remote in Washington. Employees are expected to attend in-person staff meetings at least quarterly. The role also requires maintaining RN licensure, continuing education, and role-related credentials.

Requirements

Active, unrestricted RN license or multistate RN license with legal authority to practice for members located in Washington by the position start date; ability to obtain Colorado RN licensure within the required timeframe following the start date.
At least 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.
Availability to work Monday through Friday during daytime business hours and support operations across Mountain and Pacific Time Zones.
Ability to attend in-person staff meetings at least quarterly.

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.

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 reflecting members’ goals, preferences, risks, strengths, and desired 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, and connect members with appropriate resources.
Facilitate safe transitions between hospitals, skilled nursing facilities, rehabilitation settings, home health, and members’ residences, including timely follow-up with members, caregivers, and providers.
Assess changes in condition, apply clinical judgment and approved escalation pathways, and partner with 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.
Educate members about conditions, medications, warning signs, self-management, preventive care, and available benefits 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.
Accurately and promptly document assessments, care plans, interventions, referrals, outreach attempts, outcomes, and required data 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.