ED RN Case Manager - Remote - EST or CST Preferred

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The RN Case Manager monitors real-time ‘Admit, Discharge, Transfer’ (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care.

Actively supports ED discharge follow-up care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate next site of care in collaboration with the hospitals/physician team and available outpatient ecosystem resources (PCP, specialist, in-home care, etc.).

This position requires a candidate that can be flexible, adapting as the program grows to meet the needs of the populations and markets.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have compact licenses and the ability to obtain other RN non-compact License.

Primary Responsibilities

Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for members

Independently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced- based criteria within the documentation system

Performs expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out of network facilities

Interacts and effectively communicates with ED staff, members, and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit information

Identifies member’s ED discharge support opportunities level of risk by monitoring real- time ADT feeds and communicates with patient, ED, and outpatient teams for discharge coordination

• Conducts transition of care outreach following ED discharge to confirm access and completion of discharge plan
• Manages assigned case load in an efficient and effective manner utilizing time management skills

Demonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activities

Enters timely and accurate documentation into designated applications to comply with documentation requirements and achieve audit scores of 90%25 or better monthly

Records required information into designated program tracker accurately and timely, ensuring proper KPI measurements, achieving audit scores of 90%25 or better monthly

Adheres to organizational and departmental policies and procedures

Takes On-call Assignment as Directed

• The ED Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicated
• Decision-making is based on regulatory requirements, policy and procedures and current clinical guidelines

Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms

Refers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical bounds

• Monitors for any quality concerns regarding member care and reports as per policy and procedure
• Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Performs All Other Related Duties as Assigned

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

• Current, unrestricted Multistate RN license
• 4+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditions
• 1+ years experience working in the Emergency Department
• Knowledge of utilization management, quality improvement, and discharge planning
• Rapid acuity-based clinical prioritization
• Recognizing early signs of clinical deterioration
• Identifying patients at risk for ED return visits or avoidable bounce-backs
• Credibility with ED physicians and staff*
• Understanding ED workflow, throughput, and provider decision-making*

Preferred Qualifications

• Experience with managed care and/or case management experience
• Understanding ED workflow, throughput, and provider decision-making

*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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve.

We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.