Senior RN Case Manager - Remote

Optum NY/NJ, is seeking a Senior RN Case Manager to join our team in Fishkill, NY. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and erience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country.

Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating). This includes case management, coordination of care, and medical management consulting, health education, coaching and treatment decision support. Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit. The impact of work is most often at the local level.

You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. 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.

• Maintain caseload
• Reviews the work of others
• Develops innovative approaches
• Coordinates work activities with supervisors and/or managers
• Serve as a clinical resource and coach for Complex Case, Disease and Transitional Case
• Management programs, and ED Follow-up
• Act as primary preceptor for RN and LPN Case Managers
• Assign and support preceptor for all other roles
• Support and maintenance of relationships with affordability and vendor programs, including and not limited to palliative care, continuum/fee for services programs, and patient care conferences
• Anticipates customer needs and proactively develops solutions to meet them.
• Serves as a key resource on complex and/or critical issues
• Solves complex problems and develops innovative solutions
• Performs complex conceptual analyses
• Reviews work performed by others and provides recommendations for improvement.
• Forecasts and plans resource requirements
• Authorizes deviations from standards
• May lead functional or segment teams or projects
• Provides explanations and information to others on the most complex issues
• Motivates and inspires other team members
• Conduct call monitoring and case auditing of staff and implementing performance improvement plans
• Ability to work in a fast-paced environment
• Facilitate the complaint process by engaging member, family, and caregivers telephonically
• Establish a process for member education to assist with self-management goals, disease management or acute condition
• Utilize evidenced-based practice to develop interventions
• Establish a process to utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
• Manage the quality of clinical assessments and Care Plans
• Coordinate regular clinical reviews of high-risk cases with members of the Interdisciplinary Care Team (IDCT)
• Ensure adherence to relevant state and federal guidelines (e.g., Medicare, Medicaid, SNP, Commercial) and regulatory bodies (e.g., CMS, NCQA, URAC, Inter Qual) for Complex Case, Disease and Transitional case management
• Demonstrate understanding of utilization management processes
• Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
• Monitor staff caseload in an efficient and effective manner to ensure optimal productivity
• Monitor and ensure timely and accurate…