[Hiring] RN Complex Case Manager @UnitedHealth Group

Role Description

Optum NY is seeking an RN Case Manager to join our team anywhere within the U.S. The RN Case Manager role, operating under general administrative direction, is primarily responsible for coordinating referrals from physicians and healthcare facilities for high-risk members. This position involves significant member education related to their illnesses and planned treatments. The Case Manager supports various Case Management and Quality Improvement programs, ensuring timely communication between members, providers, and health plans. Additionally, the role includes maintaining grievance files and associated documentation.

The overarching goal of the Case Manager is to identify, coordinate, and provide appropriate levels of care while managing clinical operations and medical management activities across the continuum of care. This includes:

• Assessing
• Planning
• Implementing
• Coordinating
• Monitoring
• Evaluating care

The role also encompasses health education, coaching, and treatment decision support for members, requiring a Registered Nurse (RN) qualification. The Case Manager plays a critical role in bridging the gap between healthcare providers, members, and health plans, ensuring that high-risk members receive comprehensive, coordinated, and high-quality care. The position requires strong clinical expertise, excellent communication skills, and a commitment to improving healthcare delivery.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Member Care Coordination:
  • Collaborates with physicians and multidisciplinary teams to develop and maintain up to date, coordinated care plans.
  • Acts as a liaison between members and the healthcare team to ensure effective communication and alignment of care plans.
• Member Referral Support:
  • Assists physicians, members, and families in obtaining referrals to specialists.
  • Provides counseling and support tailored to the clinical needs of the member.
• Care Plan Development:
  • Partners with designated physicians to create and maintain individualized Member Care Plans.
• Clinical Improvement:
  • Actively participates in developing and deploying Coordination of Care activities aimed at enhancing the clinical experience for both referred members and referring physicians.
• Liaison Role:
  • Facilitates communication among care team members to address the needs of both the member and the physician.
• Provider/Member Education:
  • Educates members and care team participants about available community and health plan benefits and services.

Qualifications

• Bachelor of Science in Nursing (BSN), or 5+ years case management experience in lieu of BSN
• Unrestricted current RN licensure in state of New York
• 3+ years of diverse clinical experience as a Registered Nurse; preferably in caring for the acutely ill members with multiple disease conditions
• 2+ years of experience in health plan case management, complex and disease case management
• Experience in a remote and telephonic role
• Proficient in Microsoft Office and Adobe products

Requirements

• BSN
• Commission for Case Manager Certification (CCMC)
• Experience in discharge planning
• Experience in utilization review, concurrent review, or risk management
• Background in managed care

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)