Senior RN Case Manager - Care for Me Program

Transform the future of health care with us! At our organization, we are advancing health programs that integrate comprehensive care for the best patient experiences. Join our mission of Caring. Connecting. Growing together.

As a Clinic Case Manager, you will play a vital role in supporting patients with high-risk health conditions, guiding them through the healthcare system while fostering teamwork and collaboration. You will empower patients and their families by serving as an educator, resource, and advocate, ensuring the highest quality of life. Your work will involve seamless interaction and collaboration with a diverse team of healthcare professionals, including physicians, nurses, pharmacists, and social workers. In this role, you will thrive in a dynamic, self-directed environment while fulfilling all nursing duties as outlined by your RN license according to state regulations.

Key Responsibilities:

• Collaborate closely with patients and both clinical and non-clinical teams within the primary care clinic.
• Identify and engage with a targeted panel of clinic patients as guided by the Medical Management manager.
• Support the ongoing care of patients with chronic conditions.
• Effectively communicate with patients through various channels, answering questions and addressing concerns.
• Assess health conditions and collaborate with patients, caregivers, and healthcare professionals to implement care plans that meet their needs.
• Work to decrease the risk of condition exacerbations and reduce emergency room visits and hospitalizations.
• Conduct medication reconciliations in partnership with healthcare providers as necessary.
• Utilize Motivational Interviewing and Self-Management Goal setting techniques to support patient engagement.
• Provide comprehensive patient education and resources.
• Facilitate referrals to appropriate agencies and services.
• Assist patients in transitioning from the Emergency Department or inpatient care to outpatient services.
• Evaluate transitional needs and establish contingency plans for ongoing support.
• Manage post-discharge needs, such as arranging home health care, prescriptions, and appointments.
• Standardize the individualized plan of care in collaboration with healthcare providers.
• Monitor quality measures outcomes and aim to reduce HEDIS Gaps in Care.
• Document all interactions and assessments accurately in the electronic medical record.
• Participate in team meetings and contribute to process improvements.
• Stay updated on community resources and healthcare best practices.
• Other duties as assigned to support our mission and patient care objectives.

We offer a rewarding environment that recognizes your contributions and supports your professional development.

Required Qualifications:

• Valid NV RN License.
• Current BLS Certification.
• 3+ years of experience in a healthcare setting.
• Strong knowledge of medical terminology.
• Proficient in MS Office applications.
• Outstanding communication, interpersonal, organizational, and customer service skills.
• Self-motivated with solid computer skills and attention to detail.
• Able to multitask and work effectively under pressure.
• Valid NV State Driver's license and reliable transportation.

Preferred Qualifications:

• Bachelor's degree or higher in a healthcare-related field.
• 2+ years of experience in prior authorization or case management within health plans or integrated systems.

Compensation will vary based on experience, education, and other factors, with a range of $71,200 to $127,200 annually. We are committed to creating an inclusive environment for all and offer an extensive benefits package that includes health benefits, a 401k contribution, and additional incentives.

At UnitedHealth Group, we are dedicated to improving health outcomes for all, especially those affected by health disparities. We invite you to join our team in delivering equitable care that transforms the health landscape.

OptumCare is proud to be an equal-opportunity employer and maintains a drug-free workplace; candidates must pass a drug test prior to employment.