Remote Complex Case Manager, RN, CT

Requisition Number: 2178360
Job Category: Nursing
Primary Location: Farmington, CT
(Remote considered)

If you want to get way ahead in your career, it makes sense to be with an organization that’s way ahead of the curve. Formed in 1997, ProHealth Physicians has grown to become Connecticut’s leading primary care physician organization. With over 90 locations throughout the state of Connecticut, our family of primary care doctors and specialists care for more than 360,000 people statewide. In fact, ProHealth serves every county and provides roughly ten percent of the primary care delivered to patients in the state. We’re leaders in thinking and in serving our communities.  For instance, we’re a C.M.S. approved Accountable Care Organization (ACO), covering over 30,000 Medicare patients associated with our community-based primary care providers. We’re also nationally recognized as a NCQA Level III Medical Home. That kind of progressive leadership makes us perfect fit for OptumCare and UnitedHealth Group’s expanding family of providers. This is a place where you can stay way ahead as you do your life’s best work.(sm) 

ProHealth Physicians is a physician-led medical group with 85 practice locations throughout Connecticut serving more than 10% of the state’s residents. We empower physicians and advanced clinicians to better serve patients through enhanced care processes in support of improved patient outcomes. Formed in 1997, ProHealth Physicians has grown to include more than 350 primary care and specialty clinicians and offers select specialty and diagnostic/therapeutic services. 

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

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.

Primary Responsibilities: 

• Member Care Coordination.  Works closely with physicians involved in member’s plan of care to coordinate care plan communication; works with a 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 members 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: 

• Unrestricted current CT Nursing License
• 2+ years of experience managing complex disease states
• 2+ years of telephonic health plan case management, Utilization Management or Concurrent review experience
• High proficiency with 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: 

• Bachelor’s Degree in Nursing (BSN)
• Certified Case Manager Certification (CCMC)
• 5+ years of experience as a nurse case manager
• 5+ years of experience managing complex disease states
• Knowledge and understanding of NCQA standards
• Experience in a remote work setting

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges. 

Connecticut Residents Only: The salary range for Connecticut residents is $60,000 to $106,700. 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.