Remote Nurse Case Manager, Clinical Care Coordination

Optum

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Requisition Number: 2193526
Job Category: Nursing
Primary Location: Richmond, VA
(Remote considered)

$7,500 Sign-on Bonus for External Candidates 

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. 

The Nurse Case Manager, Clinical Care Coordination in this Maternity pull through role analyzes potential candidates for Optum’s Home Care Maternity Services and promotes the conversion of those leads to referrals. This telephonic clinician will directly educate, negotiate, and coordinate with multiple members of the health care team. Contacts will include internal and external clients, i.e., participant, physician and staff, Case Managers, CM supervisors, medical directors, pharmacy associates, RMCDs, AEs, RVPs, VPs, Referral nurses, PSAs, and Center Directors.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Reviews new incoming lead data for specified clients via fax, email or portal and ensures data entry into the salesforce Business Platform
  • Monitors and maintains data integrity in Salesforce
  • Serves as expert resource to the Maternity CM team
  • Initiates outreach to physician with follow up as necessary to obtain referral
  • Coordinates appropriately with AEs, CMs, MDs, participants and Medical Directors to convert leads into Optum’s Home Care referrals
  • Resolves leads within acceptable time frame and communicates resolution to appropriate parties-
  • Executes strategies to maximize sales and revenue growth
  • Reviews and works Navihealth and CarePort Hospital discharge patients
  • Creates and distributes leads and status reports to key stakeholders
  • Analyzes clinical data for possible home care candidacy and makes solid judgments on whether or not a lead is actionable
  • Efficiently sell the Home Care benefit telephonically to clinical staff
  • Navigates the physician’s office triage and personnel to speak to correct office contact
  • Reports issues and opportunities to Supervisor
  • Sends weekly report of Wins/Losses to Supervisor
  • Creates and maintains reports to payer and internal key stakeholders
  • Other duties as assigned

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.

Years of post-high school education can be substituted/is equivalent to years of experience

Required Qualifications:

  • Active, unrestricted RN license in state of residence
  • Certified Case Manager OR the ability to obtain certification per CCMC guidelines
  • Access to install secure, high-speed internet and a dedicated workspace at home

Preferred Qualifications:

  • Active, unrestricted Multistate licensure
  • 3+ years of experience as a Nurse Case Manager
  • 3+ years of experience in High Risk Obstetrics
  • Demonstrated critical thinking skills
  • Proven ability to use multiple business and clinical systems simultaneously; Clients and System platforms are continuously evolving and require flexibility, adaptability, and training in supporting new business

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $67,800 to $133,100 per year. 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. 

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