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Job Details

UnitedHealth Group

Sr RN Case Manager - Englewood, CO


Nurse Manager



Englewood, Colorado, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

Responsible for managing up to approximately one half a case load and for providing mentoring, coaching and support for RNs/BHCMs in the field. The Clinical Advisor partners with their Manager of Case Managerment or Director of Clinical Operations (DCO) to enhance clinical expertise and adherence to Optum at Home’s clinical model.

Primary Responsibilities:

  • Clinical Advisor (Approximately 50%)
    • The RN Clinical Advisor reports to and is supported by the Manager of Case Managers or DCO
    • Partner with the Manager to ensure effective on-boarding of new clinicians and ongoing development of existing clinicians
    • Develop innovative approaches and support the implementation and adoption of new clinical and quality initiatives
    • Does not have direct reports but works in coordination with the Managers of Case Managers and/or DCO to enhance clinical expertise and adherence to the clinical model through planning and implementing the orientation and development of Case Manager staff
    • Utilize advanced clinical nursing expertise, knowledge of geriatric/chronic disease management, and the home and community setting to provide coaching, mentoring, and role-modeling to new and existing clinicians
    • Oversee and implement clinical staff development programs in collaboration with market leadership
    • Review work performed by others and provides recommendations for improvement in conjunction with supervisor
    • Serve as a resource to RN/BHCMs for escalated complex and/or clinical issues
    • Partner with clinicians and other site functions to ensure business development activities are in place to meet business goals
    • Sought out as knowledge-based expert
    • Communicate needs and issues surfaced by clinical staff to site and corporate leadership
    • Serve as a leader/ mentor
    • Promote the development of a collegial team, for coverage, troubleshooting and brainstorming
    • Foster and develop a culture of clinical expertise
    • Anticipate customer needs and proactively develop solutions to meet them
    • Solve complex problems and develop innovative solutions in collaboration with other stakeholders
    • Perform complex conceptual analyses
    • Forecast and plan resource requirements
    • Authorize deviations from standards
    • May lead functional or segment teams and/or projects
    • Provide explanations and information to others on complex issues
    • Motivate and inspire other team members
  • Primary Care Delivery (50%):
    • Perform initial review of consumer health records and current health status (e.g., health risk scores) to identify health risk and determine next steps
    • Conduct initial and ongoing assessments utilizing nursing assessment skills in home setting
    • Receive information from consumers about specific symptoms and questions
    • Conduct interviews to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
    • Evaluate consumer data throughout the assessment process to identify inconsistencies and adherence to Evidence Based Guidelines from both the health care and psychosocial / socioeconomic dimensions of care
    • Identify and prioritize gaps to develop plan of care and short and long term goals to empower consumers to meet identified goals
    • Determine consumer's willingness to engage in plan of care and readiness for change
    • Identify appropriate interventions and resources to meet gaps (e.g., psychosocial, transportation, long-term care) based on specific consumer needs from both the health care and psychosocial / socioeconomic dimensions of care
    • Document the plan of care in appropriate EHR systems and enter data per specified format
    • Maintain consumer engagement by establishing rapport, demonstrating empathy, and building a trusting relationship
    • Collaborate with primary providers or multidisciplinary team to align or integrate goals to plan of care and drive consistent coordination of care
    • Provide ongoing support for advanced care planning
    • Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals
    • Understand and operate effectively/efficiently within legal/regulatory requirements
    • Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes and achieve business results

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:

  • Undergraduate degree or equivalent experience
  • Active, un-encumbered RN license to practice nursing in the state of Colorado
  • Access to reliable transportation that will enable you to travel to client and/or other case manager sites within a designated area
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
  • 2+ years in education/mentoring

Preferred Qualifcations:

  • Experience working with complex patient populations including multiple chronic diseases with diverse psychosocial backgrounds
  • Experience working in home health or in home setting with 1+ years of experience
  • Understanding of Medicare, Medicaid and Health Plan benefit structures beneficial
  • Proficient computer skills including the ability to document medical information with written and electronic medical records
  • Effectively communicate with elderly and chronically ill patients and families
  • Comfortable working independently in a home-visit setting
  • Excellent organizational skills with the ability to multi-task and manage schedule
  • Excellent Collaboration skills and ability to communicate with care team and physicians

Knowledge & Skills:

  • Understanding of Geriatrics and Chronic Illness
  • Understanding of Advanced Illness and end of life discussions
  • Ability to develop and maintain positive customer relationships
  • Adaptability to change

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado Residents Only: The salary range for Colorado residents is $66,100 to $118,300. 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.

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.