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Complex Cases RN Case Manager Optum AZ

Optum
United States, Arizona, Phoenix
November 25, 2022

***This role is eligible for a $5000 Sign On Bonus for External Candidates***

***Please note this role is a hybrid of WFH and Field Based***

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

OptumCare is a network of health care providers in the Southwest, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. OptumCare's focus is to do the right things for patients, physicians, and the community. OptumCare's Core Business is contracting directly with health insurers to deliver a highly personal care management and service model to their patients. The current focus of OptumCare is on seniors, and those with complex care needs, who most benefit from a high touch model of care.

Our Nurse Case Managers (NCM) are RNs who are responsible for the coordination of care for patients in the inpatient and community setting to determine medical appropriateness by following medical guidelines and benefit determination. The ultimate goal is to help the patient remain out of the hospital while remaining in a safe home with a quality of life.

The RN Case Manager acts as a longitudinal advocate for patients from the time the patient is admitted to the hospital until the patient with their care givers have returned to their home. They link the patient and care givers with the network of care team members to help them gain knowledge of their disease process and to identify community resources for continued growth toward the maximum level of independence. The Nurse Case Manager is responsible for the case management activities across the continuum of care including coordination of care, development of a comprehensive care plan with any identified barriers, providing health education, coaching and treatment decision support for patients. The NCM participates in interdisciplinary conferences to review clinical assessments, update care plans and determine follow-up frequency with the team.

***This is a full time, Monday-Friday position. The RN must be able to travel within assigned territory / location area which includes but not limited to: the Southwest Valley - areas such as Tolleson, Levine, Buckeye, Glendale, Surprise, and other areas as needed in order to conduct critical face to face assessments. Territory Assignments are based on business needs and may change over time. Applicants must be willing to carry a diverse clinical caseload and visit the patient in their home, hospital, SNF and as needed in the PCP's office.***

Primary Responsibilities:



  • Collaborates effectively with interdisciplinary team (IDT) to establish an individualized plan of care for members, goals including both short and long term
  • Works with the Utilization Management RNs, Social Worker (LMSWs) Case Managers and other internal and external providers to facilitate smooth care transitions
  • Serves as the primary clinical liaison with hospital, clinical and administrative staff for a smooth, seamless transition to the next level of care
  • Stratifies and / or validates patient level of risk and communicates during transition process with IDT
  • Ensures standardized execution of workflow processes, such as increase in admissions, monthly audits, and referral to Social Workers (LMSWs)
  • Provides assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or member's home
  • Develops interventions and processes to assist Medicare and Medicaid patients in meeting short and long term plan of care goals
  • Coordinates and attends member visits with PCP and specialists as needed
  • Nurse Case Managers work with their supervisor to work their assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process
  • Confers with physician advisors on a regular basis regarding inpatient cases and participates in departmental conferencing
  • Plans patient transitions with internal medical management staff and external providers
  • Attends and participates in interdisciplinary team meetings as directed
  • With the assistance of the UM team, guides physicians and hospital staff in their awareness of preferred contracts and providers as well as facilities
  • Enters timely and accurate data into designated case management applications as needed to communicate patient needs and maintains audit scores of 95% or greater on a monthly basis as well as to be determined patient satisfactory scores


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 license in the state of AZ
  • CCM certifications is required within 2 years of hire
  • 3+ years of clinical experience in an acute care, home health, hospice, geriatric and / or hospital setting
  • Experience using EMR and CM practice guidelines
  • Experience with Microsoft Office applications including Word
  • Knowledge of discharge planning alternatives options and interdisciplinary approaches
  • Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area which includes but not limited to: Phoenix, AZ
  • Employee must complete their first attempted test by their second work anniversary. If employee does not pass the exam, they will be offered a 1-year grace period during which there are 3 more opportunities to test, given CCMC testing schedule. If employee does not pass the exam and obtain certification by the end of the 1-year grace period, next step would be termination
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation


Preferred Qualifications:



  • 2+ years of case management experience
  • Experience working with individuals with multiple co-morbidities and complex medical conditions
  • Experience with Excel and Power Point
  • Diabetes Disease case management and/or educator
  • Bilingual (English / Spanish) language proficiency
  • Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
  • Independent problem identification / resolution and decision making skills
  • Able to prioritize, plan, and handle multiple tasks/demands simultaneously


Answer the call to use your diverse knowledge and experience to make health care work better for our patients.

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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.

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