Remote Telephonic RN Case Manager

Optum; United States; Remote; USD 92,000 - 137,000; Full time

Benefits offered by this job

Comprehensive benefits

Equity stock purchase program

401(k) contribution

Job summary

Optum Home & Community Care, part of the Optum family, is hiring a Telephonic RN Case Manager to assess and plan care for members with complex needs from a remote Washington location. You will coordinate across Medicare/Medicaid, healthcare providers, and community resources to keep members safely in their preferred setting.

The role requires active RN licensure in WA, 2+ years of nursing experience, and strong telephonic communication with an emphasis on advocacy and education.

Qualifications

• Active RN license valid in WA at start date.
• Minimum 2 years of professional RN experience.
• Experience coordinating care for patients with complex needs.
• Experience with Medicaid LTSS or similar programs.
• Experience in care management or transitions of care.
• Proficient in documenting in electronic health records while speaking with members.
• Driver's license and reliable transportation.

Responsibilities

• Conduct telephonic assessments of members' medical, behavioral health, functional, psychosocial, caregiver, environmental, and socioeconomic needs.
• Develop and reassess individualized, person-centered care plans reflecting goals, risks, strengths, and independence.
• 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 appropriate resources.
• Facilitate safe transitions between hospitals, SNFs, rehab settings, home health and residence with timely follow-up.
• Assess changes in condition, apply clinical judgment and escalation pathways with care teams to address urgent needs.
• Respond to member escalations involving Medicaid agencies, health authorities, managed care orgs, families and providers.
• Provide education on conditions, medications, warning signs, self-management and benefits with clear, culturally responsive communication.
• Advocate for members and caregivers to reflect preferences in care planning and service delivery.
• Support advance care planning discussions and connect members with clinical or community resources.

Skills

RN license

RN experience

Care coordination

LTSS Medicaid

Care management

EHR navigation

Driver's license

Job description

Optum Home & Community Care, part of the Optum family, is hiring a Telephonic RN Case Manager to assess and plan care for members with complex needs from a remote Washington location. You will coordinate across Medicare/Medicaid, healthcare providers, and community resources to keep members safely in their preferred setting.

The role requires active RN licensure in WA, 2+ years of nursing experience, and strong telephonic communication with an emphasis on advocacy and education.