Registered Nurse, Case Manager (Remote)

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions.

Position in this function is responsible for completing telephonic comprehensive nursing assessments, creating care plans, participating in interdisciplinary team meetings, evaluating patient care needs, and coordinating care and benefits.

Delegates tasks as needed to professionals and para-professional employees. Coordinates activities and works closely with clinicians and staff to maintain efficient department functions and ensure the successful operation of the department. Responsible for performing operational duties as required under the supervision of the site administrator or designee. Familiar with the Model of Care and NCQA guidelines.

You’ll enjoy the flexibility to work remotely* from anywhere within the U. S. as you take on some tough challenges. This role manages patients within the California market and must be able to work PST business hours.

Primary Responsibilities

Meets telephonically with patients, patients' families, and caregivers as needed to discuss care and treatment plan

• Outreaches patients after a hospital discharge to ensure post discharge needs are met
• Consults with the physician and other team members to ensure that the care plan is successfully implemented

Uses protocols and pathways in line with established disease management and care management programs to optimize clinical outcomes and minimize unnecessary institutional care

Monitors and coaches patients using motivational interviewing techniques and behavioral change to maximize self-management

Oversees provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care

• Works in coordination with the care team and demonstrates accountability with patient management and outcome
• Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable

Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families

Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals

• Participates actively in Monthly Care Management Department meetings and daily huddles
• Documents pertinent patient information and Care Management Plan in Electronic Health Record

Coordinates care with central departments on assigned patient caseload, including inpatient, long-term care facilities, adult family homes, and home health agencies

Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports

Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions

Adheres to departmental policies and procedures. Uses, protects, and discloses HCP patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Participates in training all new care managers

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Graduation from an accredited school of nursing
• Active, unrestricted Registered Nurse license through the State of California
• 1+ years of experience in a clinical setting or care Management
• Intermediate level experience in Microsoft products including word, excel, and outlook
• Ability to work PST business hours

Preferred Qualifications

• Bachelor of Science in Nursing, BSN
• Telehealth certification
• 3+ years of experience working in acute care
• 1+ years of care management, utilization review or discharge planning experience
• HMO experience
• Ability to type 45 wpm

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.