Call Center Nurse/Telephonic RN Case Manager - 2281757

UnitedHealth Group; Eden Prairie (MN); Remote; Confidential; Full time

Job summary

A leading company is seeking a skilled RN to assess and coordinate care for members in the World Trade Center Health Program. This role involves managing a caseload, educating members, and ensuring compliance with healthcare standards. The position offers remote flexibility and requires strong communication and organizational skills. Join a mission-driven team dedicated to improving health outcomes and addressing disparities in care.

Benefits

Comprehensive Benefits Package

Incentives

Recognition Programs

Stock Options

401k Contributions

Qualifications

• 4+ years of clinical experience required.
• Current RN license or ability to obtain licensure.

Responsibilities

• Manage caseload, assess and coordinate care telephonically.
• Handle calls with providers to authorize tests and procedures.
• Review medical records for coverage eligibility.

Skills

Communication

Problem-Solving

Organizational Skills

Critical Thinking

Interpersonal Skills

Education

RN License

Equivalent Education

Tools

Microsoft Office

Job description

This position involves assessing and coordinating care for a diverse population of members in the World Trade Center (WTC) Health Program across the U.S. The role includes educating members on coverage and limitations, ensuring high-quality, cost-effective care within contract requirements, and navigating complex health conditions using critical thinking. Responsibilities also include coordinating healthcare services, summarizing medical histories for the Medical Director, and fostering relationships with members, providers, and team members to ensure compliance and satisfaction.

Schedule: Monday - Friday, 8:00 a.m. - 5:00 p.m. CST. Remote work is permitted from anywhere within the U.S., offering flexibility to handle challenging tasks.

Primary Responsibilities:

1. Manage an assigned caseload, assessing, educating, and coordinating care telephonically while maintaining detailed records in the internal database.
2. Handle inbound and outbound calls with providers to authorize tests and procedures related to members’ health conditions and coverage.
3. Review medical records to determine WTC-relatedness for coverage eligibility and communicate findings to members.
4. Complete system-generated tasks and document results in the internal database (MedNet).
5. Prepare reviews and summaries for medical appeals, coverage determinations, and treatment requests.
6. Serve as a point of contact for internal departments regarding caseload inquiries.
7. Complete health questionnaires during periods of reduced coverage.

Required Qualifications:

• Current RN license or ability to obtain licensure in the work state or a compact state.
• 4+ years of clinical experience.
• Equivalent education, experience, or military background.
• Proficiency with Microsoft Office.
• Effective interpersonal, communication, and problem-solving skills.
• Excellent organizational and multitasking abilities.
• Strong telephone communication skills.
• Ability to work independently and as part of a team.
• Initiative, attention to detail, and critical thinking skills for care planning.

Preferred Qualifications:

• National Career Readiness Certificate.
• Case management or military healthcare experience.
• Medical call center or corporate healthcare experience.
• Background in behavioral health, occupational health, or medical/surgical fields.
• Knowledge of ICD and CPT coding.
• URAC/ISO accreditation knowledge.

*Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

The hourly pay range is $28.61 to $56.06, based on factors like location, education, experience, and certifications. Benefits include a comprehensive package, incentives, recognition programs, stock options, and 401k contributions, subject to eligibility.

Our mission is to help people live healthier lives and improve the health system. We are committed to equity, addressing health disparities, and fostering an inclusive environment. OptumCare is an Equal Opportunity Employer and a drug-free workplace, requiring a drug test prior to employment.