RN Case Manager
Company: Optum
Location: Everett
Posted on: March 6, 2025
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Job Description:
Optum Home & Community Care, part of the UnitedHealth Group 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. - - - -
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As a team member of our Optum At Home product, together with an
interdisciplinary care team we help patients navigate the health
care system, and connect them to key support services. This
preventive care can help patients stay well at home. - - -
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We're connecting care to create a seamless health journey for
patients across care settings. Join us to start Caring. Connecting.
Growing together. - -
Under minimal supervision, responsible for ensuring the continuity
of care in the outpatient setting utilizing the appropriate
resources within the parameters of established contracts and
patients' health plan benefits. Facilitates continuum of patients'
care utilizing advanced nursing knowledge, experience and skills to
ensure appropriate utilization of resources and patient quality
outcomes. Performs care management functions on-site and
telephonically as the need arises. Works in conjunction with the
care team and PCP as care team leader to develop a patient centered
plan of care.
Primary Responsibilities: -
Prioritizes patient care needs upon initial visit and addresses
emerging issues
Meets with patients, patients' family and caregivers as needed to
discuss care and treatment plan
Identifies and assists with the follow-up of high-risk patients in
acute care settings, skilled nursing facilities, custodial and
ambulatory settings
Consults with physician and other team members to ensure that care
plan is successfully implemented
Coordinates treatment plans with the care team and triages
interventions appropriate to the skill set of the team members.
Uses protocols and pathways in line with established disease
management and care management programs in order to optimize
clinical outcomes and minimize unnecessary institutional care
Monitors and coaches patients using techniques of motivational
interviewing and behavioral change to maximize self-management
Oversees provisions for discharge from facilities including
follow-up appointments, home health, social services,
transportation, etc. in order to maintain continuity of care
Works in coordination with the care team and demonstrates
accountability with patient management and outcome
Discusses Durable Power of Attorney (DPOA) and advanced directive
status with patient and PCP when applicable
Maintains effective communication with the physicians,
hospitalists, extended care facilities, patients and families
Provides accurate information to patients and families regarding
resources available to them through health plan benefits, community
resources, and referrals
Participates actively in Monthly Care Management Department
meetings and daily huddles
Documents pertinent patient information and Care Management Plan in
Electronic Health Record
Coordinates care with central departments on assigned patient
caseload, including, inpatient, long term care facilities, adult
family homes, and home health agencies
Demonstrates a thorough understanding of the cost consequences
resulting from Care Management decisions through utilization
reports and systems such as Health Plan Benefits, CM dashboards and
reports
Maintains concise and accurate documentation that supports
effective and efficient management of care plans to decrease
Emergency and hospital readmissions
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: - -
Graduation from an accredited school of nursing
Basic Life Support for Healthcare providers (AHA) or CPR/AED for
the Professional Rescuer (American Red Cross)
Washington State Registered Nurse license. Basic Life Support (BLS)
for Healthcare providers (AHA)
3+ years of experience in a clinical setting
Washington State driver's license and vehicle for work-related
travel
Travel 50% within the King County Service area
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Preferred Qualifications:
Bachelor of Science in Nursing, BSN
Telehealth certification
3+ years of experience working in acute care
1+ years of care management, utilization review or discharge
planning experience
HMO experience
The salary range for this role is $59,500 to $116,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
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At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission. -
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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. -
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UnitedHealth Group is a drug-free workplace. Candidates are
required to pass a drug test before beginning employment.
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Keywords: Optum, Everett , RN Case Manager, Executive , Everett, Washington
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