Remote Complex Case Manager, RN, CT


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Requisition Number: 2208402
Job Category: Nursing
Primary Location: Farmington, CT
(Remote considered)

Opportunities with ProHealth Physicians, part of the Optum family of businesses. When you work at ProHealth Physicians, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind Caring. Connecting. Growing together.  

Position Details:

  • Location: Telecommuter position, but must be able to travel to Farmington, CT for training/meetings
  • Schedule: Full time, 40 hours/weekly, Monday through Friday, 8:00AM – 4:30PM

If you are located in Connecticut, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities: 

  • Member Care Coordination:  Works closely with physicians involved in member’s plan of care to coordinate care plan communication; works with multidisciplinary team to maintain and implement up-to-date coordinated care plan; communicates with all members of the healthcare team on behalf of the member
  • Member Referral Support:  Assists physician providers, members, and their families in obtaining referrals to needed specialists.  Provides support and counseling, as appropriate to the clinical situation
  • Care Plan Development:  Works with designated physicians to develop and maintain member care plans
  • Clinical Improvement:  Proactively participates in the development and deployment of coordination of care activities with the goal of improving the clinical experience for referred members and the referring physician
  • Liaison:  Communicates with members of the care team as appropriate to coordinate the identified member and physician’s needs
  • Provider/Member Education: Educate member and care team participants on community/health plan benefit services available
  • Performs various duties as needed to successfully fulfill the function of the position in conjunction with Medical Management as needed

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: 

  • Bachelor’s Degree in Nursing (BSN)
  • Unrestricted current CT Nursing License
  • 2+ years of experience managing complex disease states
  • 2+ years of telephonic health plan case management
  • 2+ years of utilization management or concurrent review experience
  • Knowledge and understanding of NCQA/ACO/CDO regulations and standards
  • High proficiency in navigating multiple complex computer programs (including but not limited to Microsoft Products, Adobe)
  • Experience with Electronic Health Records (Allscripts, Epic)
  • Ability to travel up to Farmington CT for training and meetings as needed. Possible travel to other locations at times

Preferred Qualifications:  

  • Master’s Degree in Nursing (MSN)
  • Certified Case Manager Certification (CCMC)
  • 5+ years of experience as a nurse case manager
  • 5+ years of experience managing complex disease states
  • Experience in a remote work setting

Connecticut Residents Only: The salary range for Connecticut residents is $58,300 to $106,300 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

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.    

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.      

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.