Remote Case Management Nurse Jobs

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 Care at Home 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. This life-changing work adds a layer of support to improve access to care. We're connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.

The Care at Home (CAH) Dual Special Needs Plan (DSNP) program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of patients (beneficiaries) in their place of residence. The CAH program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, comprised of the Care at Home team of clinicians as well as community-based health care professionals (e.g., PCP, specialists, behavioral health, pharmacy, and other providers). Optum providers serve people in their own homes through annual evaluations, longitudinal visits for higher risk beneficiaries, care coordination during transitions from the hospital or nursing home, and ongoing care management

This position is responsible for clinical outcomes, business operation targets, and overseeing the work activities of the team of Registered Nurses and Behavioral Health Case Managers.

Primary Responsibilities

• Set team direction, resolve problems, and provide guidance to members of their team
• Lead, supervise, and develop members of the CAH clinical team
• Oversee work activities of other supervisors and staff
• Adapt departmental plans and priorities to address business and operational challenges
• Influence and/or provide input to forecasting and planning activities
• Ensure team meets established performance metrics and performance guarantees
• Ensure effective orientation and development for Clinical Staff
• Utilize Complex Population Management performance tools that hold the clinical team accountable for market metrics and performance standards
• Promote individual development by providing learning and growth opportunities to clinical staff
• Communicate needs and issues addressed by clinical staff to local market and corporate leadership as appropriate
• Participate in site-specific strategic planning activities
• Develop solutions to problems or barriers by partnering with key stakeholders
• Provide clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
• Serve as a role model to internal and external partners
• Oversee implementation and adoption of clinical and quality initiatives
• Ensure team is proficient in the delivery of quality care
• Use knowledge of the business and financial goals to determine and communicate clinical priorities
• Partner with staff to achieve business goals
• Monitor and hold clinical team accountable for Model of Care documentation
• Actively engage, coach and drive clinical staff in executing activities that promote new engagement

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

• Current unrestricted RN (Registered Nurse) license
• 3+ years of related management experience with focus on managing and developing a clinical team, preferably in a home care and/or geriatric care setting
• Proven experience in developing and sustaining internal and external client relationships with healthcare professionals
• Proficient computer skills including the ability to document medical information with written and electronic medical records
• Access to reliable transportation that will enable you to travel to client and/or patient sites within a designated area

Preferred Qualifications

• Solid business acumen including analysis and business planning experience
• Knowledge of Medicare Dual (DSNP (Dual special needs plan), Chronic Plans (CSNP), and Medicaid environment
• Proven excellent communication skills and demonstrated ability to foster a culture of clinical excellence and build collaborative relationships
• Proven solid organizational skills and multitasking abilities will be keys to success
• Proven solid clinical critical thinking skills

Capacity Allocation

The following allocation is a planning guide for a typical work cycle. Actual time may shift based on patient acuity, transitions, urgent clinical needs, regulatory requirements, and market priorities.

• Clinical Operations, Quality, & Performance Management
• Accountable for clinical outcomes, performance metrics, quality initiatives, Model of Care compliance, operational execution, and ensuring delivery of high-quality care across the continuum
• People Leadership & Team Development
• Direct leadership of Registered Nurses, Behavioral Health Case Managers, and supervisors through coaching, development, team direction, performance management, onboarding, and problem resolution
• Strategic Planning, Stakeholder Engagement, & Business Growth
• Strategic planning, forecasting, stakeholder partnership, escalation and communication with leadership, business alignment, barrier resolution, and membership growth initiatives

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 $xx,xxx to $xx,xxx annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.