Remote SNF RN Case Manager – Medicare Advantage

Optum; Draper (UT); Hybrid; USD 73,000 - 130,000; Full time

Job summary

Optum is seeking a Skilled Nursing Facility (SNF) Case Manager in Draper, UT to coordinate and manage care for Medicare Advantage members in skilled nursing facilities. You will collaborate with facility staff, providers, members, caregivers, and interdisciplinary teams to support safe transitions, improve outcomes, reduce readmissions, and promote appropriate SNF length of stay.

The role requires an active Utah RN license and 3+ years of clinical nursing experience, with preferred BSN and CCM/

Qualifications

• Current, unrestricted RN license in Utah.
• 3+ years of clinical nursing experience, preferably in acute care, care management, case management, utilization management, discharge planning, or transitional care.
• Experience working within managed care, Medicare Advantage, value-based care, care management, or population health environments.
• Demonstrates case management knowledge and ability to independently assess member needs, develop care plans, prioritize interventions, and manage complex cases with minimal supervision.
• Demonstrated solid clinical assessment, critical thinking, problem-solving, and decision-making skills.
• Demonstrated excellent written, verbal, and interpersonal communication skills.
• Proven ability to collaborate effectively with providers, hospitals, skilled nursing facilities, Community Health Workers, and interdisciplinary care teams.
• Demonstrated proficiency with electronic medical records, case management systems, and Microsoft Office applications.

Responsibilities

• Manage a caseload of Medicare Advantage members admitted to skilled nursing facilities.
• Develop, implement, and monitor individualized care plans based on member needs, goals, and available resources.
• Collaborate with SNF staff, physicians, advanced practice providers, therapists, caregivers, and interdisciplinary teams to coordinate care and support positive outcomes.
• Participate in interdisciplinary care conferences and discharge planning meetings.
• Monitor member progress toward established goals and identify opportunities to improve quality, efficiency, and member experience.
• Facilitate safe transitions between care settings, including discharge to home, assisted living, community-based services, or other appropriate levels of care.
• Collaborate with Community Health Workers and interdisciplinary team members to address social determinants of health and barriers impacting care.
• Complete documentation accurately and within established timelines and regulatory requirements.
• Maintain knowledge of Medicare guidelines, post-acute care services, community resources, and care management best practices.
• Comply with all organizational, regulatory, privacy, and compliance requirements.
• Facilitate timely primary care, specialty care, and post-discharge follow-up appointments.
• Maintain accurate, timely, and complete documentation in accordance with organizational, regulatory, and accreditation requirements.
• Adhere to all applicable policies, procedures, HIPAA regulations, and quality standards.
• Participate in performance improvement, care coordination, and population health initiatives designed to improve member outcomes and reduce healthcare utilization.
• Perform other duties as assigned.

Skills

Utah RN license

Clinical nursing experience

Case management

Interdisciplinary collaboration

EMR proficiency

Microsoft Office

Education

BSN

Case Management Certification (CCM/ ACM-RN)

Tools

EMR systems

Microsoft Office

Job description

Optum is seeking a Skilled Nursing Facility (SNF) Case Manager in Draper, UT to coordinate and manage care for Medicare Advantage members in skilled nursing facilities. You will collaborate with facility staff, providers, members, caregivers, and interdisciplinary teams to support safe transitions, improve outcomes, reduce readmissions, and promote appropriate SNF length of stay.

The role requires an active Utah RN license and 3+ years of clinical nursing experience, with preferred BSN and CCM/