Nurse Case Manager - Essex County NJ

At United Healthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people to better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come.

If you are located within Essex County, New Jersey, and willing to travel up to 80% of your time to the assigned territory, you will have the flexibility to work remotely as you take on some tough challenges.

• Conduct thorough health assessments, including medical history, chronic conditions, behavioral health, and social determinants of health
• Develop individualized care plans that address medical, rehabilitation, behavioral health, and social needs
• Create personalized interventions that integrate medical treatment, support services, and community resources

• Build and maintain relationships with an established caseload of high-risk members
• Provide education to members and caregivers on disease processes, treatment adherence, and lifestyle changes
• Encourage self-management strategies that support long-term wellness and reduce complications
• Maintain consistent outreach to support adherence to care plans and monitor evolving needs

• Coordinate services across providers, including PCPs, specialists, hospitals, LTSS, behavioral health, and pharmacy
• Facilitate referrals for home health, hospice, palliative care, and DME
• Collaborate with Medical Directors during interdisciplinary rounds to review and align care for complex cases

• Support members through transitions of care such as hospitalization, skilled nursing, and rehabilitation
• Conduct "welcome home" and follow-up calls to ensure post-discharge services, medications, and follow-up appointments are in place
• Deliver intensive outreach during the 30-day post-discharge period to reduce avoidable readmissions and ED utilization
• Advocate for safe, coordinated, and timely transitions of care that align with the member's individualized care plan

• Conduct home and hospital visits in North Jersey as required by program guidelines
• Perform in-person assessments and provide care coordination to address high-risk needs and ensure continuity of care
• Collaborate directly with providers, facilities, and families during field visits to close care gaps and reinforce the care plan

• Monitor members' clinical conditions, care plan progress, and treatment adherence
• Reassess care plans regularly and adjust interventions based on changing needs or barriers
• Identify red-flag conditions and elevate urgent or complex cases for higher-level review and intervention

• Document all assessments, care plans, interventions, and communications per NCQA, CMS, and state regulatory requirements
• Ensure care management services align with DSNP/NCQA standards and contract requirements
• Track outcomes tied to quality metrics (HEDIS, STARs), utilization management, and member satisfaction
• Maintain audit readiness through timely, accurate, and comprehensive documentation

You will 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.

• Current, unrestricted RN license in New Jersey
• 2+ years of Case Management Experience serving complex, elderly and disabled
• Experience with government health programs (Medicaid/Medicare)
• Proficient in Microsoft Office Suite; tech-savvy with ability to navigate multiple systems simultaneously
• Demonstrated ability to talk and type proficiently at the same time
• Access to reliable transportation and the ability to travel up to 80% within assigned territory.
• Available for occasional in-person meetings as needed

• Certified Case Manager (CCM)
• Experience working with populations with special needs (DSNP)
• Experience with Managed Care Population
• Bilingual - English/Spanish

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package,…