Complex RN Case Manager - Remote

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives.

Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim.

We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country.

Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring.

Connecting. Growing together.

Position Details :

• Location : Telecommuter position, but must be able to travel to Secaucus, New Jersey for training / meetings
• Schedule : Full time, 40 hours / weekly, Monday through Friday, 8 : 00AM - 4 : 30PM

Primary Responsibilities :

Member Care Coordination. Works closely with physicians involved in member's plan of care to coordinate care plan communication;

works with multidisciplinary team to maintain and implement up-to-date coordinated care plan; communicates with all members of the healthcare team on behalf of the member

Member Referral Support : Assists physician providers, members and their families in obtaining referrals to needed specialists.

Provides support and counseling, as appropriate to the clinical situation

• Care Plan Development. Works with designated physicians to develop and maintain member care plans
• Clinical Improvement. Proactively participates in the development and deployment of coordination of care activities with the goal of improving the clinical experience for referred members and the referring physician
• Liaison. Communicates with members of the care team as appropriate to coordinate the identified member and physician's needs
• Provider / Member Education. Educate member and care team participants on community / health plan benefit services available

Optum NY / NJ was formed in 2022 by bringing together Riverside Medical Group, CareMount Medical, Crystal Run Healthcare and ProHealth Care.

The regional alignment combines resources and services across the care continuum - from preventative medicine to diagnostics to treatment and beyond across New York, New Jersey, and Southern Connecticut.

As a Patient Centered Medical Home, Optum NY / NJ can provide patient-focused medical care to the entire family. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation.

Together, we're making health care work better for everyone.

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 :

• Bachelor's degree in nursing (BSN)
• Unrestricted current NJ Nursing License
• 2+ years of experience managing complex disease states
• 2+ years of telephonic health plan case management
• Experience with Electronic Health Records
• Knowledge and understanding of NCQA / ACO / CDO regulations and standards
• High proficiency with navigating multiple complex computer programs (including but not limited to Microsoft Products, Adobe)
• Ability to travel up to Secaucus, NJ for training and meetings as needed.

Preferred Qualifications :

• Master's degree in nursing (MSN)
• Certified Case Manager Certification (CCMC)
• 5+ years of experience as a nurse case manager
• 5+ years of experience managing complex disease states
• 2+ years of utilization management or concurrent review experience
• Experience in a remote work setting

New Jersey Residents Only : The salary range for this role is $58,300 to $114,300 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.

UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

Diversity creates a healthier atmosphere : OptumCare is an Equal Employment Opportunity / Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.