Telephonic RN Case Manager, Care

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 s 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 Optum Care at Home program provides ongoing support for Dual Eligible Special Needs Plan (D-SNP) members with Medicare and Medicaid benefits. Through individualized care planning and targeted interventions, the program helps address complex clinical, behavioral, functional, and social needs while supporting members in their preferred care setting.

As a Telephonic RN Case Manager, you will serve as a primary point of contact for members with complex medical, behavioral health, functional, social, and long-term services and supports needs. You will conduct telephonic assessments, develop person-centered care plans, coordinate transitions and community-based services, resolve barriers to care, and support members in remaining safely in their preferred setting whenever possible.

This is high volume, customer service environment. You'll need to be efficient, productive and thorough dealing with our members over the phone. solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes.

Schedule:

Monday through Friday, daytime business hours. Candidates must be available to support operations across Mountain and Pacific Time Zones.

You'll enjoy the flexibility to work remotely*, preferably in Washington or Colorado, as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week. Employees residing in Washington are expected to attend in-person staff meetings at least quarterly. Candidates residing outside of Washington or Colorado, may be considered if they can obtain and maintain the licensure or multistate practice privileges necessary to support members in both states.

• Conduct comprehensive telephonic assessments of members' medical, behavioral health, functional, psychosocial, caregiver, environmental, and socioeconomic needs

• Develop, implement, and reassess individualized, person-centered care plans that reflect each member's goals, preferences, risks, strengths, and desired level of independence

• Coordinate care across Medicare, Medicaid, primary and specialty care, behavioral health, pharmacy, home health, long-term services and supports, and community-based programs

• Identify gaps in care and barriers to treatment, including transportation, food insecurity, housing instability, caregiver needs, financial concerns, medication access, and health literacy, and connect members with appropriate resources

• Facilitate safe transitions between hospitals, skilled nursing facilities, rehabilitation settings, home health, and the member's residence, including timely follow-up with members, caregivers, and treating providers

• Assess changes in condition, apply clinical judgment and approved escalation pathways, and partner with assigned care managers, utilization management, market leadership, and clinical teams to address urgent or complex needs

• Respond to and support resolution of member escalations involving state Medicaid agencies, health care authorities, managed care organizations, health systems, members, families, caregivers, and other stakeholders

• Provide education on conditions, medications, warning signs, self-management, preventive care, and available benefits while using clear, culturally responsive, member-centered communication

• Advocate for members and caregivers so their needs, choices, rights, and preferences are represented in care planning and service delivery

• Support advance care planning discussions and connect members with appropriate clinical or community resources consistent with program guidelines

• Document assessments, care plans, interventions,…