Complex Case Manager

Optum; United States; Remote; USD 40,000 - 72,000; Full time

Job summary

UnitedHealthcare is seeking a registered nurse to provide Complex Care Management for Idaho members remotely across the United States. You will engage in close phone-based communication, educate on conditions, perform medication reviews, and connect members to benefits and community resources.

You will collaborate with Care Coordinators to align outreach, care plans, and service coordination, while meeting Idaho-specific contractual requirements and supporting NCQA certification efforts.

Qualifications

• Current, unrestricted RN in the applicant's state of residence.
• 2+ years clinical experience in a hospital, acute care, home health/hospice, direct care or case management.
• 1+ years of experience directly working with individuals with special healthcare needs.
• Intermediate level of proficiency with computer/typing to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications.
• Access to high-speed internet from home.
• Ability to support Idaho members while working remotely from anywhere within the U.S.; Idaho residency is not required.

Responsibilities

• Provide Complex Care Management for Idaho members through close communication by phone
• Support members with condition education, medication reviews and connections to covered benefits, community resources and long-term services and supports, when applicable
• Assist members with the transition from a care facility back to their home
• Support NCQA Care Management requirements through UHC's Care Management program, including assessment, care planning, member outreach, coordination, monitoring and documentation
• Collaborate with each member's assigned Care Coordinator to align outreach, care plan activities, service coordination, follow-up needs and escalation pathways
• Meet Idaho-specific contractual requirements related to the delivery of care management and member-centered coordination
• Support Idaho health plan in obtaining NCQA certification

Skills

RN license

Remote work

Computer skills

Internet access

Care coordination

Education

Bachelor's degree

Job description

At UnitedHealthcare, we are simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provide Complex Care Management for Idaho members through close communication by phone
• Support members with condition education, medication reviews and connections to covered benefits, community resources and long-term services and supports, when applicable
• Assist members with the transition from a care facility back to their home
• Support NCQA Care Management requirements through UHC's Care Management program, including assessment, care planning, member outreach, coordination, monitoring and documentation
• Collaborate with each member's assigned Care Coordinator to align outreach, care plan activities, service coordination, follow-up needs and escalation pathways
• Meet Idaho-specific contractual requirements related to the delivery of care management and member-centered coordination
• Support Idaho health plan in obtaining NCQA certification

You will be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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 RN in the applicant's state of residence
• 2+ years clinical experience in a hospital, acute care, home health/hospice, direct care or case management
• 1+ years of experience directly working with individuals with special healthcare needs
• Intermediate level of proficiency with computer/typing to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
• Access to high-speed internet from home
• Ability to support Idaho members while working remotely from anywhere within the U.S.; Idaho residency is not required

Preferred Qualifications:

• Bachelor's degree
• Certification in Case Management (CCM)
• 2+ years of clinical experience in a behavioral health setting
• Case Management experience
• Home care/field-based case management experience
• Medicaid, Medicare, Managed Care experience
• Experience with vulnerable subpopulations include children and youth with special health care needs, adults with serious mental illness, members with substance use disorders and members with other complex or multiple chronic conditions

*All Telecommuters 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.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

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.

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