Description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.**
We are looking for a **Case Manager RN** as an addition to the team. The Case Manager drives Referral Management and appropriate sites of service, facilitates Care Transitions and Care for High-Risk patients; Collaborates with PCP, Specialists, and Spectrum Clinical Pharmacist to ensure appropriate, coordinated service delivery. This position integrates pharmacy management, care coordination, utilization management, and care transition management.
If you reside in Florida, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.
**Hours:** Monday - Friday - 8 AM - 5 PM EST - with 2 days that you can work to 7 PM EST
**Primary Responsibilities:**
Work with a Care Team of a Clinical Pharmacist and Clinical Administrative Coordinator to support patient and provider engagement for Care Transitions Management, Care Coordination, and Medication Therapy Management
Facilitate inpatient discharge information to Care Team and Primary Care Offices using appropriate technology tools
Consult with patients who have had an inpatient discharge; facilitate scheduling transitions of care follow up appointments with PCP and/or specialists
Consult with patients who have had an ED discharge; facilitate scheduling follow-up appointments as needed; review post-discharge information with patients and educate on alternative sites of care
Engage high-risk patients telephonically to schedule appointments with Clinical Pharmacist for Comprehensive Medication Reviews
Prepare patient cases in workflow management platform for Clinical Pharmacist patient engagement
Consult with patients identified as needing a specialist referral to recommend high quality, lower cost specialists
Support high-risk patients by scheduling PCP and/or specialist appointments on their behalf
Provide benefit information and resources to patients upon request
Communicate with provider offices to problem-solve patient issues and/or facilitate communication between practice staff and Care Team
Notify PCP and Care Team Clinical Pharmacist of relevant clinical information gathered during calls to patient that may affect the patient's disease state or medication regimen
Develop strong relationships with provider offices participating with Practice Extend program by communicating program goals, patient needs, and value-based opportunities
Facilitate and/or lead meetings with provider offices for initial onboarding meetings and ongoing collaboration meetings
**What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:**
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
More information can be downloaded at:
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 (or higher)
Unrestricted, compact licensure as a Registered Nurse for applicable states within our program
4+ years of Case Management and/or Care Coordination experience
3+ years of experience in managing populations with complex medical or behavioral needs
Intermediate level of proficiency with Microsoft Office, Outlook, and Teams applications and ability to quickly learn clinical applications and multi system management
Intermediate level of ability to type and navigate a Window-based environment simultaneously
Able to travel up to 10% to local office(s) to accommodate business needs
Ability to work a flexible schedule, including evenings up to 7pm, to accommodate business needs
**Preferred Qualifications:**
Strong communication skills with patients, providers, and other healthcare professionals
Clinical or Behavioral Health degree
Prior experience in managed care and/or population health management
Background in healthcare setting with an understanding of chronic conditions and best practices
Ability to provide proactive clinical feedback to enhance quality patient engagement and program growth
Able to take initiative and work independently
Adaptable, flexible, and able to incorporate frequent process changes into established workflows within a fast-paced, dynamic environment
Spanish/English Bilingual (include if there are language preferences for the region/market)
Pediatric Nursing background
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
-At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.-
-Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants wi
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