This Washington-based position combines field-based and telephonic care management for individuals enrolled in Medicaid Long-Term Services and Supports (LTSS) and Dual Special Needs Plan (DSNP) programs across Washington and Colorado. The role supports members with complex medical, behavioral, functional, and social needs through in-home assessments, individualized care planning, care coordination, transitions of care, and ongoing case management.
The Care at Home (CAH) program delivers coordinated, member-centered care through an interdisciplinary team that includes Nurse Practitioners, Registered Nurse Case Managers, Behavioral Health Case Managers, Care Navigators, primary care providers, specialists, and community partners. Together, the team helps members remain safely in their homes while addressing clinical, behavioral health, and social determinants of health needs.
Registered Nurse Case Managers (RNCMs) spend approximately 75% of their time conducting in-home visits and community-based care coordination throughout Washington State and approximately 25% providing telephonic case management support to members in both Washington and Colorado. This role requires independent field work, collaboration across multiple care settings, and active partnership with internal and external care team members to support quality outcomes and member-centered care.
Position Highlights & Primary Responsibilities
- Conduct in-home assessments, care coordination visits, and community-based member engagement throughout Washington State, representing approximately 75% of work time
- Provide telephonic case management and care coordination support for Care at Home members in Washington and Colorado, representing approximately 25% of work time
- Assess the health status of patients within the scope of licensure and with the frequency established in the model of care
- Establish goals to meet identified health care needs
- Plan, implement, and evaluate responses to the plan of care
- Work collaboratively with the interdisciplinary team to engage resources and strategies to address medical, functional, and social barriers to care
- Works closely with mental health clinicians to help bridge the gap between mental and physical health
- Review Daily on Call Report to monitor assigned patients calling into Urgent Care and schedule with APC/RN as clinically indicated
- Consult with the patient's PCP, specialists, or other health care professionals as appropriate
- Assess patient needs for community resources and make appropriate referrals for service
- Facilitate the patient's transition within and between health care settings in collaboration with the primary care physician and other treating physicians
- Complete and accurately document in patient's electronic medical record
- Provide patients and family members with education regarding health maintenance, disease prevention, condition trajectory and need for follow up as appropriate during each patient visit
- Verify and document patient and/or family understanding of condition, plan of care and follow up recommendations
- Actively participate in organizational quality initiatives
- Participate in collaborative interdisciplinary team meetings to optimize clinical integration, efficiency, and effectiveness of care delivery
- Initiate and respond to both internal and external referrals as clinically indicated
- Maintain credentials essential for practice, to include licensure, certification (if applicable) and CEUs
- Demonstrate a commitment to the mission, core values and goals of UnitedHealthcare and its healthcare delivery including the ability to integrate values of compassion, integrity, performance, innovation and relationships in the care provided to our patients
Required Qualifications
- Active unrestricted RN licensure in state of residence and state of assignment, compact licensure or ability to obtain individual state RN licensure to support Care at Home markets
- 2+ years of experience as a Registered Nurse
- Experience in assessing the medical needs of patients with complex behavioral, social and/or functional needs
- Experience with Medicaid Long Term Care, Long-term Services and Supports (LTSS), Home-and Community-Based Services, or a closely related Medicaid care management program
- Proven ability to work with diverse care teams in a variety of settings including non-clinical settings (primarily patient homes)
- Demonstrated solid computer skills, including use of Electronic Medical Records
- Ability to physically navigate home settings, lift 30 pounds
- Ability to travel up to 75% of the time throughout assigned Washington service areas for field-based member visits; valid driver's license and reliable transportation required
Preferred Qualifications
- Certified Case Management (CCM) Certification
- Behavioral health experience as RN
- Experience coordinating Medicaid Long Term Care, Long-term Services and Supports (LTSS)
- Proven effective time management and communication skills
- Demonstrated knowledge of Washington or Colorado Medicaid programs, health care systems, and community organizations serving older adults, people with disabilities, and individuals with complex needs
The salary for this role will range from $60,200 - $107,400 annually based on full-time employment.