RN Case Manager

Optum Home & Community Care, part of the UnitedHealth Group 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 At Home product, together with an interdisciplinary care team 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.   

We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. 
 

Under minimal supervision, responsible for ensuring the continuity of care in the outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients' health plan benefits. Facilitates continuum of patients' care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site and telephonically as the need arises. Works in conjunction with the care team and PCP as care team leader to develop a patient centered plan of care.

Primary Responsibilities: 

• Prioritizes patient care needs upon initial visit and addresses emerging issues
• Meets with patients, patients' family and caregivers as needed to discuss care and treatment plan
• Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings
• Consults with physician and other team members to ensure that care plan is successfully implemented
• Coordinates treatment plans with the care team and triages interventions appropriate to the skill set of the team members. Uses protocols and pathways in line with established disease management and care management programs in order to optimize clinical outcomes and minimize unnecessary institutional care
• Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management
• Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc. in order to maintain continuity of care
• Works in coordination with the care team and demonstrates accountability with patient management and outcome
• Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable
• Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families
• Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals
• Participates actively in Monthly Care Management Department meetings and daily huddles
• Documents pertinent patient information and Care Management Plan in Electronic Health Record
• Coordinates care with central departments on assigned patient caseload, including, inpatient, long term care facilities, adult family homes, and home health agencies
• Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports
• Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions

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:  

• Graduation from an accredited school of nursing
• Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross)
• Washington State Registered Nurse license. Basic Life Support (BLS) for Healthcare providers (AHA)
• 3+ years of experience in a clinical setting
• Washington State driver’s license and vehicle for work-related travel
• Travel 50% within the King County Service area

Preferred Qualifications:

• Bachelor of Science in Nursing, BSN
• Telehealth certification
• 3+ years of experience working in acute care
• 1+ years of care management, utilization review or discharge planning experience
• HMO experience

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. 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.

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 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. 

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