[Hiring] RN Case Manager @UnitedHealth Group

Role Description

Optum UT is seeking a RN Case Manager - ED to join our team in Draper, UT. The RN Case Manager (ED) provides telephonic proactive case management services to members with frequent Emergency Department (ED) utilization, focusing on reducing avoidable ED visits and hospital admissions through early intervention, care coordination, and patient engagement. This role works collaboratively with providers, caregivers, community resources, and interdisciplinary teams to address clinical, behavioral, and social determinants of health that contribute to unnecessary ED utilization.

• Deploy RN case management support for identified high-risk and frequent ED utilizers within assigned markets
• Conduct comprehensive assessments to identify clinical, psychosocial, behavioral health, and social determinants of health needs
• Deliver proactive outreach, care coordination, and longitudinal member engagement to promote self-management and care plan adherence
• Reinforce primary care provider (PCP) engagement and facilitate timely follow-up appointments
• Provide education to members and caregivers regarding disease management, symptom recognition, medication adherence, and appropriate care settings
• Identify and address root causes of ED utilization, including care gaps, access barriers, social needs, and behavioral health concerns
• Connect members to appropriate programs and services, including Complex Case Management, Disease Management, Behavioral Health, Social Work, and community-based resources
• Utilize ED diversion strategies to support treatment in the most appropriate setting and prevent avoidable hospital admissions
• Monitor member progress and adjust interventions based on changing healthcare needs and risk factors
• Document all assessments, interventions, care plans, and outcomes in accordance with organizational and regulatory requirements
• Support organizational goals related to utilization management, quality improvement, HEDIS/HOS measures, patient satisfaction, and population health outcomes
• Perform other duties as assigned

Qualifications

• Current, unrestricted Registered Nurse (RN) license in Utah
• 3+ years of clinical nursing experience, preferably in acute care, care management, case management, utilization management, discharge planning, or transitional care
• Experience working within managed care, Medicare Advantage, value-based care, care management, or population health environments
• Demonstrated case management knowledge and ability to independently assess member needs, develop care plans, prioritize interventions, and manage complex cases with minimal supervision
• Proven solid clinical assessment, critical thinking, problem-solving, and decision-making skills
• Proven excellent written, verbal, and interpersonal communication skills
• Ability to collaborate effectively with providers, hospitals, skilled nursing facilities, Community Health Workers, and interdisciplinary care teams
• Proficiency with electronic medical records, case management systems, and Microsoft Office applications

Requirements

• Preferred Qualifications:
• Bachelor’s degree in nursing (BSN)
• Case Management Certification (CCM, ACM-RN, or equivalent)
• Experience supporting transitions of care, readmission prevention, post-acute care management, or emergency department utilization programs
• Knowledge of community resources and social determinants of health

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)
• Salary range: $72,800 - $130,000 annually based on full-time employment