Field RN Case Manager (Medicaid LTSS) - Optum Care at Home

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care.

We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs — helping patients access and navigate care anytime and anywhere.

As a team member of our Optum Care at Home team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home.

This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across care settings. Join us in improving healthcare through the power of people and intelligent technologies while Caring. Connecting. Growing together.

This Washington-based position combines field-based and telephonic care management for individuals enrolled in Medicaid Long-Term Services and Supports (LTSS) and Dual Special Needs Plan (DSNP) programs across Washington and Colorado. The role supports members with complex medical, behavioral, functional, and social needs through in-home assessments, individualized care planning, care coordination, transitions of care, and ongoing case management.

The Care at Home (CAH) program delivers coordinated, member-centered care through an interdisciplinary team that includes Nurse Practitioners, Registered Nurse Case Managers, Behavioral Health Case Managers, Care Navigators, primary care providers, specialists, and community partners. Together, the team helps members remain safely in their homes while addressing clinical, behavioral health, and social determinants of health needs.

Registered Nurse Case Managers (RNCMs) spend approximately 75%25 of their time conducting in-home visits and community-based care coordination throughout Washington State and approximately 25%25 providing telephonic case management support to members in both Washington and Colorado. This role requires independent field work, collaboration across multiple care settings, and active partnership with internal and external care team members to support quality outcomes and member-centered care.

Position Highlights & Primary Responsibilities

Conduct in-home assessments, care coordination visits, and community-based member engagement throughout Washington State, representing approximately 75%25 of work time

Provide telephonic case management and care coordination support for Care at Home members in Washington and Colorado, representing approximately 25%25 of work time

Assess the health status of patients within the scope of licensure and with the frequency established in the model of care

• Establish goals to meet identified health care needs
• Plan, implement, and evaluate responses to the plan of care
• Work collaboratively with the interdisciplinary team to engage resources and strategies to address medical, functional, and social barriers to care
• Works closely with mental health clinicians to help bridge the gap between mental and physical health
• Review Daily on Call Report to monitor assigned patients calling into Urgent Care and schedule with APC/RN as clinically indicated
• Consult with the patient’s PCP, specialists, or other health care professionals as appropriate
• Assess patient needs for community resources and make appropriate referrals for service
• Facilitate the patient’s transition within and between health care settings in collaboration with the primary care physician and other treating physicians
• Complete and accurately document in patient’s electronic medical record

Provide patients and family members with education regarding health maintenance, disease prevention, condition trajectory and need for follow up as appropriate during each patient visit

Verify and document patient and/or family understanding of condition, plan of care and follow up recommendations

Actively Participate in Organizational Quality Initiatives

• Participate in collaborative interdisciplinary team meetings to optimize clinical integration, efficiency, and effectiveness of care delivery
• Initiate and respond to both internal and external referrals as clinically indicated
• Maintain credentials essential for practice, to include licensure, certification (if applicable) and CEUs

Demonstrate a commitment to the mission, core values and goals of UnitedHealthcare and its healthcare delivery including the ability to integrate values of compassion, integrity, performance, innovation and relationships in the care provided to our patients

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

Active unrestricted RN licensure in state of residence and state of assignment, compact licensure or ability to obtain individual state RN licensure to support Care at Home markets

• 2+ years of experience as a Registered Nurse
• Experience in assessing the medical needs of patients with complex behavioral, social and/or functional needs

Experience with Medicaid Long Term Care, Long-term Services and Supports (LTSS), Home-and Community-Based Services, or a closely related Medicaid care management program

Proven ability to work with diverse care teams in a variety of settings including non-clinical settings (primarily patient homes)

• Demonstrated solid computer skills, including use of Electronic Medical Records
• Ability to physically navigate home settings, lift 30 pounds

Ability to travel up to 75%25 of the time throughout assigned Washington service areas for field-based member visits; valid driver's license and reliable transportation required

Preferred Qualifications

• Certified Case Management (CCM) Certification
• Behavioral health experience as RN
• Experience coordinating Medicaid Long Term Care, Long-term Services and Supports (LTSS)

Proven Effective Time Management and Communication Skills

Demonstrated knowledge of Washington or Colorado Medicaid programs, health care systems, and community organizations serving older adults, people with disabilities, and individuals with complex needs

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 salary for this role will range from $60,200 - $107,400 annually 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.