Medical Behavioral RN Case Manager - Remote

Optum; Everett (WA); Remote; USD 60,000 - 107,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

OptumCare seeks an experienced MB I NCM in Washington to join the clinical network as a direct liaison between care delivery and members. The role includes evaluating needs, coordinating care plans, and collaborating with providers to promote quality outcomes.

Responsibilities span high-risk member screening, in-home visits, CMS-compliant documentation, and using EMR systems. Travel up to 75% locally is required; clinical licensure and strong HIPAA practices are essential for success.

Qualifications

• Active and unrestricted RN license required.
• 2+ years of RN experience in care management or related field.
• Strong communication skills and HIPAA-compliant handling of information.
• Ability to travel locally up to 75% for patient home visits.

Responsibilities

• Screens and identifies high-risk members for care management and monitors utilization.
• Performs member evaluations and on-site visits across multiple settings.
• Develops individualized care plans compliant with CMS requirements.
• Documents status, diagnoses, medications, goals and interventions in EMR.
• Collaborates with nurses, physicians and coordinators to coordinate care.
• Advocates for members to ensure their needs are met by the care team.
• Assists MD consultation on complex cases and applies professional theory.

Skills

Communication

HIPAA compliance

Initiative

Teamwork

Independent work

Travel readiness

Education

RN license

Tools

Microsoft Word

Job description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Optumcare Medical Behavioral Integration Nurse Case Manager (MBI NCM) is a direct clinical liaison between OptumCare/Care Delivery organization customers and the clinical network. This position integrates a collaborative process which assesses plans, implements, coordinates, monitors and evaluates options and services to meet the member's health needs, using education, communication and all available resources to promote quality, cost-effective outcomes.

If you are located in Washington, you will have the flexibility to work in the field/remotely* as you take on some tough challenges.

Primary Responsibilities:

• Screens and identifies members with high-risk, long term chronic conditions who will benefit from care management services. Monitors utilization as needed. Referrals for cases may originate from various sources
• Performs member evaluations and onsite visits as needed in multiple settings, including but not limited to: telephonic, member's homes, PCP/Specialists clinic, hospital, and skilled nursing facilities and provides feedback on planned interventions and outcomes of the plan of care
• Performs comprehensive assessments, identifies and assists members with high-risk symptoms/diagnoses and/or members with multiple co-morbidities who will benefit from intervention and engaging in care management services, information is collected from the patient, caregiver(s), health care providers and other relevant parties as needed
• Documents findings and develops individualized careplans in a concise/comprehensive manner compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
• Utilizes advanced clinical skills to make effective decisions to meet the member's health, behavioral health and psychosocial needs, providing coaching, patient education, communication, and all available resources to promote quality and cost-effective outcomes
• Documents patient/family status, diagnosis, medications, treatment plan, goals, interventions, evaluation results, observations and progress in electronic medical record/proprietary database in a timely and accurate manner
• Advocates for members and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
• Integrates a collaborative approach by attending interdisciplinary team meetings with nurses, physicians and patient care coordinators regarding patient care as needed; Collaborates with providers to determine acuity of behavioral health concerns and refer members to appropriate community resources
• Utilizes professional knowledge and critical thinking skills to facilitate MD consultation on complex and/or complicated cases
• Applies Nursing/Counseling/Social Work theory, knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function
• Manages assigned case load in an efficient and effective manner

You will 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 and unrestricted licenses
• RN with 2+ years of experience
• Proficient computer skills and good working knowledge of Microsoft Word
• Proven ability to maintain direct and open communication with all levels of the organization
• Proven ability to handle sensitive issues with members and providers in a confidential manner according to HIPAA guidelines
• Demonstrates initiative in achieving individual, team, and organizational goals and objectives
• Demonstrated ability and flexibility to assume responsibilities and tasks in a constantly changing work environment
• Ability to travel locally up to 75% of the time for patient home visits
• Driver's License and access to reliable transportation

Preferred Qualifications:

• 2+ years of experience in a related field-based case management
• Medical/Behavioral setting experience (i.e. hospital, managed care organization, or joint medical/behavioral outpatient practice)
• Dual diagnosis experience with mental health and substance abuse
• Experience working in an environment that required coordination of benefits and utilization of multiple groups and resources for patients
• Experience working with low-income populations
• Experience working with the aged, blind or disabled
• Clinical training experience
• Proven excellent customer service skills
• Proven excellent interpersonal and problem-solving skills
• Demonstrated solid team player and team building skills
• Demonstrated solid oral and written communication skills, specifically telephone skills
• Demonstrated ability to function independently and responsibly with minimal supervision

*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 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.

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.