Optum UT is seeking a RN Case Manager - ED to join our team in Draper, UT. 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 (ED) provides telephonic proactive case management services to members with frequent Emergency Department (ED) utilization, focusing on reducing avoidable ED visits and hospital admissions through early intervention, care coordination, and patient engagement. This role works collaboratively with providers, caregivers, community resources, and interdisciplinary teams to address clinical, behavioral, and social determinants of health that contribute to unnecessary ED utilization. The RN Case Manager supports members across the continuum of care to improve health outcomes, enhance member experience, and promote appropriate healthcare utilization. This position plays a key role in ED diversion efforts and admission prevention.
If you are located in Utah, you will have the flexibility to work remotely* as you take on some tough challenges. All candidates must have an active and unrestricted Utah RN license.
Position Highlights & Primary Responsibilities
- Deploy RN case management support for identified high-risk and frequent ED utilizers within assigned markets
- Conduct comprehensive assessments to identify clinical, psychosocial, behavioral health, and social determinants of health needs
- Deliver proactive outreach, care coordination, and longitudinal member engagement to promote self-management and care plan adherence
- Reinforce primary care provider (PCP) engagement and facilitate timely follow-up appointments
- Provide education to members and caregivers regarding disease management, symptom recognition, medication adherence, and appropriate care settings
- Identify and address root causes of ED utilization, including care gaps, access barriers, social needs, and behavioral health concerns
- Connect members to appropriate programs and services, including Complex Case Management, Disease Management, Behavioral Health, Social Work, and community-based resources
- Utilize ED diversion strategies to support treatment in the most appropriate setting and prevent avoidable hospital admissions
- Monitor member progress and adjust interventions based on changing healthcare needs and risk factors
- Document all assessments, interventions, care plans, and outcomes in accordance with organizational and regulatory requirements
- Support organizational goals related to utilization management, quality improvement, HEDIS/HOS measures, patient satisfaction, and population health outcomes
- Perform other duties as assigned
Required Qualifications
- Current, unrestricted Registered Nurse (RN) license in Utah
- 3+ years of clinical nursing experience, preferably in acute care, care management, case management, utilization management, discharge planning, or transitional care
- Experience working within managed care, Medicare Advantage, value-based care, care management, or population health environments
- Demonstrated case management knowledge and ability to independently assess member needs, develop care plans, prioritize interventions, and manage complex cases with minimal supervision
- Proven solid clinical assessment, critical thinking, problem-solving, and decision-making skills
- Proven excellent written, verbal, and interpersonal communication skills
- Ability to collaborate effectively with providers, hospitals, skilled nursing facilities, Community Health Workers, and interdisciplinary care teams
- Proficiency with electronic medical records, case management systems, and Microsoft Office applications
Preferred Qualifications
- Bachelor's degree in nursing (BSN)
- Case Management Certification (CCM, ACM-RN, or equivalent)
- Experience supporting transitions of care, readmission prevention, post-acute care management, or emergency department utilization programs
- Knowledge of community resources and social determinants of health
Key Performance Indicators
- Meets outreach and engagement goals for assigned members
- Completes initial outreach and assessments within established timeframe
- Maintains member engagement throughout the transition period
- Facilitates timely follow-up care and coordination of services
- Supports reduction in avoidable readmissions and emergency department utilization
- Identifies and addresses barriers to successful care transitions
- Collaborates effectively with Community Health Workers, providers, and interdisciplinary teams
- Maintains timely and accurate documentation
- Meets productivity and quality performance standards
- Contributes to improved member outcomes and care experience
The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.