Job Description

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Nurse Case Manager (NCM) is responsible for Complex Case Management, Disease Management and Transitional Case Management, including longitudinal engagement, coordination for discharge planning, and outpatient member management through the care continuum. Nurse Case Manager identifies, screens, tracks, monitors, and coordinates the care of members with multiple comorbidities and/or psychosocial needs and develops action and/or discharge plans. The Case Manager may perform telephonic and/or face-to-face assessments, interacting and collaborating with an interdisciplinary care team (IDT) that includes physicians, pharmacists, and social workers. They advocate for members, linking them to community resources for maximum independence, and participate in IDT conferences to review care plans and member progress.

You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some challenges. This is a remote position, but candidates must reside in the Mid-West and work with CST and EST Time Zone.

Primary Responsibilities:

• Provide transition of care calls to discharged members to ensure necessary services are received according to the transition plan.
• Conduct transition discharge assessments onsite and/or via telephone to identify member needs at the transition to lower levels of care.
• Serve as a clinical liaison with hospitals for discharge planning and next site of care needs.
• Make referrals to community sources and programs in partnership with the care team.
• Engage members, families, and caregivers to establish and continually assess a coordinated action plan.
• Assess healthcare, educational, and psychosocial needs upon initial referral to care management.
• Provide member education for self-management goals and develop indicated action plans.
• Develop interventions considering member barriers using evidence-based practice.
• Utilize motivational interviewing to understand cause and effect, gather health history, and determine health literacy.
• Conduct initial assessments for members with Complex Case, Disease, and Transitional Case Management needs within designated time frames.
• Manage assessments regarding member treatment plans and establish collaborative relationships with physicians and providers.
• Collaborate with the IDT to establish individualized transition or action plans for members.
• Confer with UM Medical Directors regarding high-risk cases and participate in departmental huddles.
• Ensure adherence to NCQA requirements for Complex Case Management.
• Assist with data collection and closing care gaps and quality metrics as assigned.
• Maintain knowledge of company products and customer issues through training and self-directed research.
• Manage assigned caseload efficiently using time management skills.
• Enter accurate documentation into care management applications to comply with documentation requirements.
• Maintain licensure, certifications, and comply with all department policies and procedures.
• Identify opportunities for process improvement in all aspects of member care.

Required Qualifications:

• Current, Unrestricted RN license; Compact State Licensure.
• 3+ years of clinical experience, preferably with acutely ill members with multiple conditions.
• Knowledge of utilization management, quality improvement, and discharge planning.
• Proficiency in Microsoft Office applications.
• Ability to utilize critical thinking and decision-making skills independently.
• Reside in the Mid-West and work with CST and EST Time Zone.

Preferred Qualifications:

• Bachelor’s Degree in Nursing.
• Experience in managed care, Complex Case Management, or similar settings.
• Knowledge of DSNP NCQA requirements.
• Certification in Case Management (CCM) preferred.

Physical & Mental Requirements:

• Ability to lift up to 25 pounds, sit or stand for extended periods, and use fine motor skills.
• Receive and comprehend instructions verbally and/or in writing.

• All employees working remotely must adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range for this role is $59,500 to $116,600 annually. In addition to salary, UnitedHealth Group offers benefits such as a comprehensive package, incentive programs, stock purchase options, and 401k contributions.

UnitedHealth Group is committed to helping people live healthier lives and delivering equitable care that addresses health disparities.

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