Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

The Nurse Case Manager (NCM) supports the primary visiting provider (PVP) in assessing and managing the overall patient care management process.  In addition, the Nurse Case Manager will identify and collaborate on innovative actions to meet the needs of OPTUM patients from both the health care and psychosocial / socioeconomic dimensions of care; as well as taking action for provision of services to meet the patient needs. The NCM provides oversight, guidance and support for the patient care plan as developed in collaboration with the PVP. This care plan is based on the comprehensive history & physical completed by the PVP and the nursing assessment. The NCM uses both assessments and ongoing telephonic assessments to help guide treatment and care decisions of the team with a focus on trigger management to prevent adverse outcomes.  In addition the NCM collaborates with the health plan and additional heath care vendors to meet the needs of the patient and also identifies services and vendors for needed care while navigating patient benefit plans. 

The Nurse Case Manager will ensure that all pertinent documentation is in the medical record in a manner compliant with CMS, OPTUM and client requirements.  
 
   
Primary Responsibilities: 

• Conduct initial and ongoing assessments utilizing nursing assessment skills 
• Develop and implement an effective care plan to meet the needs of OPTUM community patients from both the health care and psychosocial / socioeconomic dimensions of care
• Advocate for the patient in all activities including nursing assessments, care coordination, care plan development, and communication. 
• Identify triggers for hospitalization and develop (in collaboration with members of the care team) an effective care plan
• Communicate and collaborate with other members of the health care team (PCP, PVP, CMA, health plan) to coordinate all needed care and service
• Provide ongoing patient education leveraging written material as available/approved by the health plan
• Provide ongoing support of patients with advance care planning
• Provide 24/7 support for the PVPs as needed

  
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. 

One year of post-high school education can be substituted/is equivalent to one year of experience.

Required Qualifications: 

• Active unrestricted RN state license 
• 5+ years of nursing experience 
• Experience working in a skilled nursing or hospital setting 
• Ability to travel to various skilled nursing facilities within a thirty-mile radius
• Excellent organizational skills with the ability to multi-task
• Experience working within a team environment

Preferred Qualifications: 

• Case Management certification
• IV certification 
• Prior case management experience
• Understanding of Medicare, Medicaid, and Health Plan benefit structures beneficial
• Managed care, utilization management, risk management, quality management, case management experience helpful
• Familiarity with ICD-9 and CPT-4 coding
• Bi-lingual or multi-lingual 
• Excellent organizational skills with the ability to multi-task

 
 
Connecticut Residents Only: The salary range for Connecticut residents is $56,300 to $110,400 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

  
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.    
 
 
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.