Remote RN Case Manager - Telephonic Care Navigator

UnitedHealth Group; Seattle (WA); A distancia; USD 92.000 - 137.000; Jornada completa

Descripción de la vacante

Optum Home & Community Care in the United States seeks a Telephonic RN Case Manager to assess members’ medical, behavioral, and social needs, and to build person-centered care plans. This role emphasizes high-volume telephone support, thorough documentation, and collaboration with interdisciplinary teams to promote safe, home-based care.

You will coordinate care across Medicare/Medicaid programs, document outcomes, and advocate for members, while maintaining licensure and complying with

Formación

• Active, unrestricted RN license or multistate RN license with authority to practice in WA by start date, with ability to obtain CO RN licensure within required timeframe.
• 2+ years of professional RN experience.
• Experience coordinating care for patients or members with complex or high-risk needs.
• Experience with Medicaid LTSS, Home- and Community-Based Services, or related Medicaid care management program.
• Experience in case management, managed care, community health, or transitions of care.
• Proficiency documenting in electronic health records and navigating multiple computer apps while speaking with members by phone.
• Driver's License and reliable transportation.

Responsabilidades

• Conduct comprehensive telephonic assessments of members' medical, behavioral health, functional, psychosocial, caregiver, environmental, and socioeconomic needs.
• Develop, implement, and reassess individualized, person-centered care plans.
• Coordinate care across Medicare, Medicaid, primary and specialty care, behavioral health, pharmacy, home health, and community programs.
• Identify gaps in care and barriers to treatment and connect members with resources.
• Facilitate safe transitions between hospitals, SNFs, rehab, home health, and members' residences.
• Assess changes in condition, apply clinical judgment and escalation pathways with care managers and clinical teams.
• Respond to and support resolution of member escalations involving Medicaid agencies, health authorities, and other stakeholders.
• Provide education on conditions, medications, warning signs, self-management, and benefits.
• Advocate for members and caregivers to reflect needs and preferences in planning and delivery.
• Support advance care planning discussions and connect with resources per guidelines.
• Document assessments, plans, interventions, referrals, and outcomes in EHR/care management systems.
• Use evidence-based standards and regulatory requirements when coordinating services.
• Maintain RN licensure, CE, and role credentials.

Conocimientos

RN license

2+ years RN experience

Care coordination

Medicaid LTSS

Case management

Electronic health records

Driver's license

Descripción del empleo

Optum Home & Community Care in the United States seeks a Telephonic RN Case Manager to assess members’ medical, behavioral, and social needs, and to build person-centered care plans. This role emphasizes high-volume telephone support, thorough documentation, and collaboration with interdisciplinary teams to promote safe, home-based care.

You will coordinate care across Medicare/Medicaid programs, document outcomes, and advocate for members, while maintaining licensure and complying with