Telephonic RN Case Manager, Optum Care at Home - Remote in Washington

UnitedHealth Group; Seattle (WA); Remote; USD 92,000 - 137,000; Full time

Job summary

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

Qualifications

• 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.

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.
• 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.

Skills

RN license

2+ years RN experience

Care coordination

Medicaid LTSS

Case management

Electronic health records

Driver's license

Job description

Requisition number: 2402124

Job category: Nursing

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Optum Care at Home team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. This life-changing work adds a layer of support to improve access to care. We're connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.

The Optum Care at Home program provides ongoing support for Dual Eligible Special Needs Plan (D-SNP) members with Medicare and Medicaid benefits. Through individualized care planning and targeted interventions, the program helps address complex clinical, behavioral, functional, and social needs while supporting members in their preferred care setting.

As a Telephonic RN Case Manager, you will serve as a primary point of contact for members with complex medical, behavioral health, functional, social, and long-term services and supports needs. You will conduct telephonic assessments, develop person-centered care plans, coordinate transitions and community-based services, resolve barriers to care, and support members in remaining safely in their preferred setting whenever possible.

This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes.

Schedule : Monday through Friday, daytime business hours. Candidates must be available to support operations across Mountain and Pacific Time Zones. This position will cover Washington and Colorado markets.

You will work remotely in Washington. Employees expected to attend in-person staff meetings at least quarterly.

Primary 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

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Active, unrestricted RN license or multistate RN license with legal authority to practice for members located in Washington by the position start date, with the ability to obtain Colorado RN licensure within required timeframe following 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 Long-Term Services and Supports (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 and navigating multiple computer applications while speaking with members by phone

• Driver's License and access to reliable transportation

Preferred Qualifications:

• Certified Case Manager (CCM) certification or another relevant case management credential

• Knowledge of Washington or Colorado Medicaid programs, health care systems, and community organizations serving older adults, people with disabilities, and individuals with complex needs

• Experience coordinating long-term care, personal care services, private duty nursing, home health, or other home- and community-based services

• Experience with utilization management, utilization review, discharge planning, concurrent review, or risk management

• Experience working effectively with interdisciplinary teams in a remote or telephonic care management environment

• Reside in Washington

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,500 to $137,300 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.