Remote Telephonic RN Case Manager: Care Navigator

UnitedHealth Group; Colorado Springs (CO); Remote; USD 60,000 - 107,000; Full time

Job summary

UnitedHealth Group's Optum Care at Home team is seeking a Telephonic RN Case Manager to provide high-quality, member-centered care for individuals with complex medical and social needs. This role conducts assessments, develops care plans, and coordinates services by phone.

You will work in a remote-capable environment across Mountain and Pacific time zones, requiring strong clinical judgment, EHR proficiency, and the ability to navigate Medicaid programs. An active RN license is required.

Qualifications

• Active, unrestricted RN license or multistate license with authority to practice for members located in both Washington and Colorado by the position start date
• 2 years of professional RN experience
• Experience coordinating care for patients or members with complex or high-risk medical, behavioral health, functional, or social needs
• Experience with Medicaid LTSS, Home- And Community-Based Services, or a closely related Medicaid care management program
• Experience in case management, managed care, community health, home health, ambulatory care, population health, transitions of care, or another setting involving longitudinal care coordination
• Proficiency documenting in electronic health records or care management platforms while speaking with members by phone
• Driver's License and access to reliable transportation

Responsibilities

• 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 that reflect each member's goals, preferences, risks, strengths, and desired level of independence
• Coordinate care across Medicare, Medicaid, primary and specialty care, behavioral health, pharmacy, home health, long-term services and supports, and community-based programs
• Identify gaps in care and barriers to treatment, including transportation, food insecurity, housing instability, caregiver needs, financial concerns, medication access, and health literacy, and connect members with appropriate resources
• Facilitate safe transitions between hospitals, skilled nursing facilities, rehabilitation settings, home health, and the member's residence, including timely follow-up with members, caregivers, and treating providers
• Assess changes in condition, apply clinical judgment and approved escalation pathways, and partner with assigned care managers, utilization management, market leadership, and clinical teams to address urgent or complex needs
• Respond to and support resolution of member escalations involving state Medicaid agencies, health care authorities, managed care organizations, health systems, members, families, caregivers, and other stakeholders
• Provide education on conditions, medications, warning signs, self-management, preventive care, and available benefits while using clear, culturally responsive, member-centered communication
• Advocate for members and caregivers so their needs, choices, rights, and preferences are represented in care planning and service delivery
• Support advance care planning discussions and connect members with appropriate clinical or community resources consistent with program guidelines
• Document assessments, care plans, interventions, referrals, outreach attempts, outcomes, and required data accurately and promptly in designated electronic health record and care management systems
• Use evidence‑based practice standards, medical necessity criteria, and applicable Medicare, Medicaid, contractual, legal, and regulatory requirements when coordinating services
• Maintain required RN licensure, continuing education, and role‑related credentials

Skills

RN license

Multistate license

2+ years RN experience

Care coordination

Medicaid LTSS experience

Case management

EHR documentation

Driver's license

Job description

UnitedHealth Group's Optum Care at Home team is seeking a Telephonic RN Case Manager to provide high-quality, member-centered care for individuals with complex medical and social needs. This role conducts assessments, develops care plans, and coordinates services by phone.

You will work in a remote-capable environment across Mountain and Pacific time zones, requiring strong clinical judgment, EHR proficiency, and the ability to navigate Medicaid programs. An active RN license is required.