RN Case Manager – Crystal Run Healthcare – Remote

Optum NY, (formerly Optum Tri-State NY) is seeking a RN Case Manager to join our team! You will train in Middletown for two to three weeks and then become a remote employee. There may be times during the year that you will be required to attend on-site meetings.
Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.
The RN Case Manager is responsible for Complex Case Management, Disease Management and Transitional Case Management. As part of an interdisciplinary team, you will be working with our patients and their caretakers encompassing coordination for discharge planning, transition of care needs and outpatient member management. You will identify, screen, track, monitor and coordinate the care of members with multiple co-morbidities and/or psychosocial needs and develop a patient’s action plan and/or discharge plan. The RN Case Manager will perform telephonic and may have face-to-face assessments. You will act as an advocate for members and their families linking them to other members of the team to help them gain knowledge of their disease process(s) and to identify community resources for maximum level of independence.
If you are located in New York state, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:

Provide members with transition of care calls to ensure that discharged members receive the necessary services and resources according to transition plan

Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care

Independently serves as the clinical liaison with hospital, clinical and administrative staff within our documentation system for discharge planning and/or next site of care needs

In partnership with care team, make referrals to community sources and programs identified for members

Engage member, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health status

Provide member education to assist with self-management goals, disease management or acute condition and provide indicated action plan

Collaborates effectively with Interdisciplinary Care Team to establish an individualized transition plan and/or action plan for members

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:

Registered Nurse licensed to practice in New York State (NYS) with current NYS registration and in good standing

3+ years of diverse clinical experience; preferred in caring for the acutely ill members with multiple disease conditions

Experience and proficiency working with electronic medical records

Knowledge of utilization management, quality improvement and discharge planning

Knowledgeable in Microsoft Office applications including Outlook, Word and Excel

Preferred Qualifications:

Bachelor of Science in Nursing (B.S.N.)

Current BLS certification

CURO experience

Experience with Complex Case Management and DSNP NCQA requirements

Proven ability to read, analyze and interpret information in medical records, and health plan documents

Proven ability to problem solve and identify community resources

Proven ability to possess planning, organizing, conflict resolution, negotiating and interpersonal skills

Proven independently utilizes critical thinking skills, nursing judgement and decision-making skills

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
New York Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. 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.
Optum NY/NJ was formed in 2022 by bringing together Riverside Medical Group, CareMount Medical, Crystal Run Healthcare and ProHealth Care. The regional alignment combines resources and services across the care continuum – from preventative medicine to diagnostics to treatment and beyond across New York, New Jersey, and Southern Connecticut. As a Patient Centered Medical Home, Optum NY/NJ can provide patient-focused medical care to the entire family. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation. Together, we’re making health care work better for everyone.
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.

UnitedHealth Group