Remote RN Case Manager — Telephonic Care Coordination

LeadingAge Virginia; Los Alamitos, Northern (CA, KY); Hybrid; USD 40,000 - 72,000; Full time

Job summary

Optum is seeking a licensed RN to perform telephonic comprehensive nursing assessments, create care plans, and coordinate care within the California market. This role supports remote work from anywhere in the U.S. and requires PST business hours.

Responsibilities include care coordination, collaboration with physicians, patients, and families, and documentation in EHR. Experience in care management and state licensure are essential, with BSN preferred.

Qualifications

• Graduation from an accredited school of nursing.
• Active, unrestricted Registered Nurse license through the State of California.
• 1+ years of experience in a clinical setting or care Management.
• Intermediate level experience in Microsoft products including word, excel, and outlook.
• Ability to work PST business hours.

Responsibilities

• Meets telephonically with patients, patients' families, and caregivers as needed to discuss care and treatment plan.
• Outreaches patients after a hospital discharge to ensure post discharge needs are met.
• Consults with the physician and other team members to ensure that the care plan is successfully implemented.
• Uses protocols and pathways in line with established disease management and care management programs to optimize clinical outcomes and minimize unnecessary institutional care.
• Monitors and coaches patients using motivational interviewing techniques and behavioral change to maximize self-management.
• Oversees provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care
• Works in coordination with the care team and demonstrates accountability with patient management and outcome.
• Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable.
• Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families.
• Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals.
• Participates actively in Monthly Care Management Department meetings and daily huddles.
• Documents pertinent patient information and Care Management Plan in Electronic Health Record
• Coordinates care with central departments on assigned patient caseload, including inpatient, long-term care facilities, adult family homes, and home health agencies
• Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports
• Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions
• Adheres to departmental policies and procedures. Uses, protects, and discloses PHI only in accordance with HIPAA standards
• Participates in training all new care managers

Skills

RN license CA

Care management

Microsoft Office

Communication

Education

Active CA RN license

BSN preferred

Tools

Microsoft Word

Excel

Outlook

Job description

Optum is seeking a licensed RN to perform telephonic comprehensive nursing assessments, create care plans, and coordinate care within the California market. This role supports remote work from anywhere in the U.S. and requires PST business hours.

Responsibilities include care coordination, collaboration with physicians, patients, and families, and documentation in EHR. Experience in care management and state licensure are essential, with BSN preferred.