Want to learn more before applying for this role? Click here to view the Realistic Job Preview: Telephonic_Case_Manager_Optum.pdf
Looking for a new and exciting opportunity to use your clinical and assessment skills in a telephonic work at home based position? Come join our growing RN Case Manager team. We have openings in NY, NJ, and TN states. As a RN Case Manager with OptumHealth, you'll have the opportunity to assist our members in managing their overall health by providing education, access to community based resources and referrals as needed.
Locations: We have 2 openings - one in the NY or NJ area, and the other in TN. Candidates must reside AND be a licensed RN from either of these 3 states to be considered.
Work Schedule: Mon- Fri with flex start time of 8:00 am - 10:30 am (est) to end time of 8:00pm (est)
As a RN Case Manager, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating. This may include case management, coordination of care and medical management consulting. You will also be responsible for providing health education, coaching and treatment decision support for members. RN Case Managers work in a telephonic work at home setting.
Primary responsibilities of a RN Case Manager include:
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Conducting initial and follow-up telephonic assessments within designated timeframes on members
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Assessing the member's current medical and social circumstances to identify any gaps or barriers that would impact compliance with their prescribed treatment plan
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Engaging the member, their family or caregiver as well as other healthcare providers to assure that a well-coordinated treatment plan is established
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Facilitating problem resolution with members, providers, and other agencies or entities as needed
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Utilizing holistic approaches to member care and integrating the member's life and motivational goals into the treatment plan
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Prioritizing care needs, setting goals and developing a treatment plan (or plan of care) that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation
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Tracking the member's health status and progress in achieving clinical and personal goals
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Interacting with Medical Directors on challenging cases
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Encouraging members to make healthy lifestyle changes
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Documenting and tracking findings
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Utilizing Milliman criteria to determine if patients are in the correct hospital setting
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Making welcome home calls to ensure that discharged member receive the necessary services and resources
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