Senior RN Case Manager - Remote

Senior RN Case Manager – Fishkill, NY Job Overview This position is responsible for clinical operations and medical management activities across the continuum of care, including case management, coordination of care, medical management consulting, health education, coaching, and treatment decision support. The role coordinates and supervises daily activities of the business support, technical, or production team or unit. Remote flexibility: You have the option to work remotely from anywhere within the United States, while remaining based in Fishkill, NY. Key Responsibilities Maintain caseload Reviews the work of others Develops innovative approaches Coordinates work activities with supervisors and/or managers Serve as a clinical resource, coach for Complex Case, Disease, and Transitional Case Management Manage programs, and ED Follow-up Act as primary preceptor for RN and LPN Case Managers Assign and support preceptor for all other roles Support and maintain relationships with affordability and vendor programs, including palliative care, continuum/fee for services programs, and patient care conferences Anticipate customer needs and proactively develop solutions Serve as a key resource on complex and/or critical issues Resolve complex problems and develop innovative solutions Perform complex conceptual analyses Review work performed by others and provide recommendations for improvement Forecast and plan resource requirements Authorize deviations from standards Lead functional or segment teams or projects Provide explanations and information to others on the most complex issues Motivate and inspire team members Conduct call monitoring and case auditing of staff; implement performance improvement plans Work in a fast‑paced environment Facilitate the complaint process by engaging members, families, and caregivers telephonically Establish a process for member education to assist with self‑management goals, disease management, or acute condition Utilize evidence‑based practice to develop interventions Establish a process to utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy Manage the quality of clinical assessments and Care Plans Coordinate regular clinical reviews of high‑risk cases with members of the Interdisciplinary Care Team (IDCT) Ensure adherence to relevant state and federal guidelines and regulatory bodies for Complex Case, Disease and Transitional case management Demonstrate understanding of utilization management processes Maintain in‑depth knowledge of company products and services as well as customer issues and needs Monitor staff caseload efficiently to ensure optimal productivity Monitor and ensure timely and accurate documentation in the care management electronic software system to comply with documentation requirements and achieve audit scores of 95% or better monthly Attend meetings and participate in committees as requested Identify opportunities for process improvement in all aspects of member care Support data collection and closing of care gaps and quality metrics as assigned; assist healthcare team in meeting quality metrics Maintain strict confidentiality Adhere to all department/organizational policies and procedures Perform all other related duties as assigned Required Qualifications Current, unrestricted RN license in both New York and New Jersey Bachelor of Science in Nursing (BSN) Associate of Science in Nursing 5+ years of diverse clinical experience; preferred in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management 2+ years of diverse clinical experience, preferably in managed care, Complex Case Management, Disease Management and Transitional Case Management Proven expert knowledge of case management principles, evidenced by certification in Case Management (CCM) or willingness to obtain within 12 months of employment Proven knowledge of relevant state and federal guidelines and regulatory bodies People‑management experience, including motivational leadership, ability to implement performance improvement plans, and drive to see employees succeed Experience managing direct reports to performance metrics Proficient with Microsoft Office and Adobe products Remote work experience Preferred Qualifications 5+ years of managed care, Complex Case Management experience 1+ years of recent leadership experience with ability to build high‑performing teams Disease Management and Transitional Case Management experience Knowledge of utilization management, quality improvement, and discharge planning Ability to cultivate a solid internal culture designed around collaboration, feedback, motivation, and accountability Solid communication and interpersonal skills Demonstrated ability to work in a fast‑paced, multi‑tasking team environment while meeting deadlines Highly skilled in leading change efforts and building partnerships with business‑line executives Ability to summarize complex issues and problems into concise reports focused on key findings and outcomes Ability to consistently manage up and down Ability to complete initiatives with minimal supervision Proficiency in developing communication strategies for a wide array of audiences that support strategic objectives Demonstrated sophisticated written and verbal presentation abilities; experience with developing presentation materials Proven proficiency in time management, flexibility, and influencing colleagues to meet demanding timelines Salary & Benefits Salary range: $72,800 to $130,000 annually for full‑time employment. Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase program, and 401(k) contribution. Eligibility requirements apply. Equal Opportunity OptumCare is 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. Drug‑Free Workplace OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr