RN Case Manager - HouseCalls - Remote - EST or CST - Compact license Required 2366228 | Columbia, MD | Remote

Telephone Case Manager RN

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 team member of our Optum HouseCalls team, together in an interdisciplinary care environment, 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 settings. Join us to start Caring. Connecting. Growing together.

We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come.

The HouseCalls Clinical Support Team (HCCST) supports Advanced Practice Clinicians in the HouseCalls business by providing telephonic consultation to plan members post HouseCalls visit. This position is completely telephonic in a call center environment. Goals of the program include providing a one-time outreach to members for follow up post HouseCalls visit to provide education and clarification on any concerns raised during their HouseCalls visit. The main objective of this program is to ensure successful transition of care from the HouseCalls Advanced Practice Clinician back to the members Primary Care Provider.

This team includes nurse care managers and social workers. The Nurse Care Manager (NCM) will report directly to the Manager/or Director of Clinical Operations of HCCST. The NCM interacts via telephonic consult with members and providers to assist with education and clarification on any concerns raised during the HouseCalls visit and ensure the member has/or assist in obtaining an appointment with the provider to transition care. They work to ensure members receive quality customer service by answering questions, addressing concerns, providing education, providing resource information, and entering referrals.

You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Perform telephonic outreach to members identified by the Advance Practice Clinician for specific referral related issues
• Ensure member has scheduled appointment with Primary Care Provider (PCP)/specialty provider; help scheduling appointment, if needed
• Refer members to internal departments such as Social Work, or Clinical Help Desk when appropriate
• Gather clinical information telephonically from patient/family
• Assist patients/members with urgent needs requiring acute intervention that arise during the call
• Identify triggers for hospitalization and barriers to meeting healthcare goals as they arise during the call
• Complete required documentation in compliance with auditing standards and policies
• Provide patient/family education on disease process and trigger management that arise during the call or are related to referral reasons
• Assist with connections to appropriate community resources if needed
• Understand and maintain confidentiality of legal and ethical issues
• Maintains compliance with all HIPAA (Health Insurance Portability and Accountability Act) regulations
• Enhance the experience of both internal and external customers by providing excellent customer service while maintaining production metrics
• Serving as a clinical resource and consultant for other clinicians
• Attend and participate in team huddles and staff meetings
• Collaborating with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies
• Provide cross-coverage support across the team and assist with special projects, as needed
• Assume other duties as assigned and directed by the Supervisor or Manager of Clinical Call Center Operations

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:

• Undergraduate Degree
• Current, unrestricted Compact RN (Registered Nurse) license in the state. (Additional licensure in assigned states must be obtained within 6 months of hire)
• 3+ years of clinical experience as a Registered Nurse in a hospital, acute care, home health/hospice, direct care, or case management position
• Ability to work at home in a call center environment that requires:
• Being on the phone with members/providers for majority of shift
• Being at your desk majority of shift excluding breaks and lunches
• Have or the ability to obtain High speed Internet connection
• Ability to manage telephonic systems for production purposes
• Dedicated workspace that is HIPAA compliant for working with PHI
• Proficient with Microsoft Word, Outlook, and Excel
• Computer/typing proficiency to enter and retrieve data in electronic clinical records
• Proven solid critical thinking skills
• Proven ability to problem solve
• Proven ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
• Proven ability to perform positively and efficiently in production driven environment

Preferred Qualifications:

• Bachelor's Degree
• Case Management experience
• Home care/field-based case management or telephonic case management experience
• Medicaid, Medicare, or Managed Care experience
• Bilingual skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group 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.

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