Remote Nurse Care Manager – Franklin, TN

Optum

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Requisition Number: 2224219
Job Category: Nursing
Primary Location: Franklin, TN
(Remote considered)

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.

 

As a team member of our HouseCalls product, we provide annual clinical assessments to patients in the comfort of their homes. This important preventive care helps identify and reduce health risks for patients, in addition to coordinating appropriate follow-up care to improve health and well-being.

 

We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together. 

 

The Housecalls Clinical Support Team (HCCST) supports Advanced Practice Clinicians in the HouseCalls and Complex Care Management businesses by providing telephonic consultation to plan members and their healthcare providers in a call center environment, receiving and processing orders, providing member education on disease process, and coordinating care of members with other healthcare professionals. This team includes certified medical assistants, licensed practical nurses, nurse care managers, pharmacists, and social workers.

 

The Nurse Care Manager (NCM) will report directly to the Manager of Clinical Operations of HCCST. The NCM interacts with members and providers to assist with clinical resources, telephonic support, patient specific care plans and other communications and supportive tasks. They work to ensure members receive quality customer service by answering questions, addressing concerns, providing education, providing resource information, and entering referrals.
You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

The schedule for this role is Monday through Friday from 9AM to 5:30PM in your local time zone.

 

Primary Responsibilities: 

  • Perform telephonic care management consultations with members, promoting high quality, evidence-based practice recommendations
    • Ensure member has scheduled appointment with Primary Care Provider (PCP)/specialty provider; help scheduling appointment, if needed
    • Refer members to internal departments such as Social Work or Pharmacy, when appropriate
  • Gather clinical information telephonically from patient/family
  • Assess patients/members for urgent needs requiring acute intervention
  • Identify triggers for hospitalization and barriers to meeting healthcare goals
  • Completing care management assessments of members past medical history, disease states, and medications
  • Provide patient/family education on disease process and trigger management
  • Collaborate with patient to develop self-management goal and monitors progress towards meeting the goal
  • Assist with connections to appropriate community resources
  • Utilize patient trigger in the development of patient-centric plan of care, which directs the focus of
  • Primary Care Provider (PCP) visits and Nurse Care Manager (NCM) calls
  • Collaborate and coordinate with PCP, Caregivers, Care Manager Assistants (CMA), health plan case managers/service coordinators and other healthcare professionals to meet the specific needs of the patient
  • Participate in case conferences and interdisciplinary care team meetings as required
  • Process orders from Primary Visiting Provider
  • Document all communications, consults and efforts in appropriate internal databases/systems according to established procedures
  • Understand and maintain confidentiality of legal and ethical issues
  • Maintains compliance with all HIPAA (Health Insurance Portability and Accountability Act) regulations
  • Enhance the experience of both internal and external customers by providing excellent customer service
  • Serving as a clinical resource and consultant for other clinicians
  • Attend and participate in team huddles and staff meetings
  • Working with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies
  • Provide cross-coverage support across the team and assist with special projects, as needed
  • Assume other duties as assigned and directed by the Supervisor or Manager of Clinical Call Center Operations

 

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: 

  • Current, unrestricted Compact RN (Registered Nurse) license in the state (Additional licensure in assigned states must be obtained within 6 months of hire)
  • 3+ years of clinical experience in a hospital, acute care, home health/hospice, direct care, or case management position
  • Computer/typing proficiency to enter and retrieve data in electronic clinical records
  • Proficient with Microsoft Word, Outlook, and Excel
  • Proven solid problem-solving skills
  • Proven ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
  • Proven ability to perform positively and efficiently in production driven environment

Preferred Qualifications: 

  • Case Management experience
  • Home care/field-based case management or telephonic case management experience
  • Medicaid, Medicare, or Managed Care experience
  • Bilingual skills

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

 

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for this role is $58,300 to $114,300 annually. 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.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.