Field RN Case Manager - Home Health and Care Coordination

Jobtome; Lakewood (CA); Remote; USD 92,000 - 137,000; Full time

Benefits offered by this job

Sign-on bonus

Job summary

Optum Home & Community Care is seeking a Registered Nurse (RNCM) to deliver in-home care within the Care at Home program. You will work with an interdisciplinary team to assess needs, create and adjust care plans, and provide教育 and support during home visits and telephonic outreach.

You will document in the EMR, collaborate with PCPs and specialists, and help bridge mental and physical health needs while traveling up to 75% to patient homes across the service area.

Qualifications

• Active unrestricted RN licensure in state of residence and state of assignment.
• 2+ years of relevant experience in home health or related settings.
• Experience with patients with complex behavioral, social and/or functional needs.
• Proven ability to collaborate with diverse care teams in home settings.
• Proficient computer skills, including EMR.
• Willingness to travel up to 75%.
• Valid driver's license and transportation.

Responsibilities

• Assess health status and set goals within the care model.
• Plan, implement, and evaluate responses to the plan of care.
• Collaborate with interdisciplinary team to address medical, functional, and social barriers.
• Bridge mental and physical health with care teams.
• Document in the electronic medical record.
• Educate patients and family on health maintenance and follow-up.
• Coordinate referrals and transitions across care settings.
• Maintain credentials and participate in quality initiatives.

Skills

RN clinical skills

EMR proficiency

Travel up to 75%

Strong communication

Education

RN licensure (active, unrestricted)

Tools

EMR systems

Job description

Optum Home & Community Care is seeking a Registered Nurse (RNCM) to deliver in-home care within the Care at Home program. You will work with an interdisciplinary team to assess needs, create and adjust care plans, and provide教育 and support during home visits and telephonic outreach.

You will document in the EMR, collaborate with PCPs and specialists, and help bridge mental and physical health needs while traveling up to 75% to patient homes across the service area.