Case Manager Nurse - Optum Frontier Therapies

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 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 Case Manager Nurse in Optum Frontier Therapies will directly support our clinical model serving patients with rare diseases by developing relationships with patients while conducting assessments specific to their therapy. This role will be under direct supervision from the Clinical Operations Supervisor.

Candidate must be willing to work 8:30am-5:00pm Pacific time.

• Conduct comprehensive patient level assessments over the phone with documentation in proprietary platform
• Conduct meaningful conversations with patients and their caregivers to understand the need for interventions to enhance their overall health outcomes and develop care plans
• Manage inbound and outbound calls from patients and caregivers while maintaining quality services levels
• Develop relationship with clinical pharmacist staff as partners in the overall care continuum of the patient
• Communicate with providers office and their staff as appropriate for patient needs
• Conduct adverse event, product complaint, and special situation conversations with patient. Document and engage with clients as appropriate per program requirement.
• Adheres to all operations, practices and procedures to meet all licensing and standards requirements established by local, state and federal agencies as well as accrediting bodies (e.g. ACHC, URAC)
• Ensures compliance with all controlled substances related rules, regulations, company policies and maintains proper communication and coordination with other departments and staff
• Compliance to and education for all accreditation programs including ACHC, URAC, etc.
• Compliance to all REMS program requirements, as applicable.
• Monitors for compliance with all HIPAA regulations, adherence to all State and Federal regulations and laws, accrediting bodies, adherence to all pharmacy accepted standards of practice
• Willingness to support clinical functions including prior authorization and appeal reviews, override requests, and inbound and outbound patient and provider education calls.
• Provides insight to platform improvement(s) and process improvement(s)
• Willingness to obtain all licenses as required to service patients living in any state or territory
• Completes special duties or projects as assigned by leadership

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.

• An unencumbered Registered Nurse in the state of residence
• Nurse Licensure Compact (NLC)
• Verification or certificate from an approved school of Nursing
• 5+ years of experience in patient facing field (Required)

• Multistate licensure in state(s) not participating in Nurse Licensure Compact
• Experience in the rare disease space
• Experience with telephony-based care services
• Baseline proficiency in the entire prior authorization and appeals process for specialty prescription medications, infusions, medical procedures and devices to provide cross functional support as deemed appropriate
• Possess solid verbal and written communication skills, interpersonal relationship skills
• Exceptional organizational, time management skills working toward hard deadlines to meet key performance metrics
• Excellent troubleshooting, problem solving and interpersonal skills effective with multiple levels / professional disciplines as well as patients, families, staff and physicians
• Be a team player and collaborate across functions

Pay is based on several factors including but not limited to local labor markets,…