Registered Nurse Field Case Manager - Optum Care at Home - DC, MD, VA

$5,000 Sign-on Bonus for External Candidates 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 member of our Optum Care at Home team, we help patients navigate the health care system and connect them to key support services, enabling patients to stay well at home and improving access to care across settings. This position is open to candidates who live in DC, MD, or VA. This is a field-based position in the greater Washington D.C. area. Expect to spend about 50‑75% of your time in the field visiting our members in their homes or in long‑term care facilities in the local area. You will need to be flexible, adaptable and, above all, patient in all types of situations. Standard hours are Monday – Friday during normal daytime business hours (no on‑call, no weekends or holidays required). Primary Responsibilities Assess, plan and implement individualized care management interventions for each member, directing them toward the most appropriate and least restrictive level of care. Develop and implement care‑plan interventions throughout the continuum of care as a single point of contact. Communicate with all stakeholders the required health‑related information to ensure quality coordinated care and services are provided expeditiously to all members. Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team. Identify appropriate interventions and resources to meet gaps (e.g., psychosocial, transportation, long‑term care) based on specific consumer needs from both the health care and psychosocial / socioeconomic dimensions of care. Document the plan of care in appropriate EHR systems and enter data as specified. Maintain consumer engagement by establishing rapport, demonstrating empathy, and building a trusting relationship. Collaborate with primary providers or multidisciplinary team to align or integrate goals to the plan of care and drive consistent coordination of care. Provide ongoing support for advanced care planning. Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals. Understand and operate effectively within legal/regulatory requirements. Utilize evidence‑based guidelines (e.g., medical necessity guidelines, practice standard). Make outbound calls and receive inbound calls to assess members' current health status. Identify gaps or barriers in treatment plans. Provide member education to assist with self‑management. Make referrals to outside sources. Provide a complete continuum of quality care through close communication with members via in‑person or on‑phone interaction. Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels. You will be rewarded and recognized for your performance in an environment that will challenge you, give you clear direction on what it takes to succeed, and provide development opportunities for other roles you may be interested in. Required Qualifications Current unrestricted Registered Nurse license in Washington D.C., or the ability to obtain one within 90 days of hire date. Certified in Basic Life Support. 2+ years of experience working with MS Word, Excel and Outlook. 1+ year of experience in post‑acute care, such as long‑term care. 1+ year of experience using an Electronic Medical Records system. Valid Driver's License and reliable transportation. Ability to work in a field‑based capacity in Washington, D.C. Reside within 50 miles of Washington, DC. Preferred Qualifications Certified Case Management (CCM). 1+ years of Clinical Case Management experience. 1+ years of experience working with the geriatric population. 1+ years of LTSS (Long Term Services and Supports). 1+ years of HCBS (Home and Community Based Services) experience. Field‑based experience entering members' homes. Experience creating care plans. Background in managing populations with complex medical or behavioral needs. Pay is based on several factors including local labor markets, education, work experience, certifications, and is in the range of $60,200 – $107,400 annually for full‑time employment. In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (all benefits are subject to eligibility requirements). We comply with all applicable minimum wage laws. 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. OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr Association of California Nurse Leaders