RN Complex Case Manager - Remote on PST

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

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

Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member’s health, social determinants, and gaps in care Creates and implements a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient’s needs and goals Performs ongoing updates of the care plan to evaluate effectiveness, and to document barriers, interventions, and goal achievement Partners with primary providers or multidisciplinary team members to align or integrate goals to plan of care Completes telephonic visits for member engagement and enrollment Uses motivational interviewing to evaluate, educate, support, and motivate change during member contacts Identifies and considers appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed Ensures compliance with quality metrics specific to health plan delegation and accrediting body requirements Conducts self and peer audits on a regular and assigned timeline Maintains caseload per defined medical management department standards Sustains productivity and audit requirements per medical management department standards Demonstrates ability to work independently and implement innovative approaches to complex member situations Determines need for continued member management, creates care plan and facilitates transition to medical management programs Attends departmental meetings and provides constructive recommendations for process improvement Performs other duties as assigned