Case Manager Nurse - Remote in California

Opportunities at Change Healthcare, part of the Optum family of businesses. We are transforming the health care system through innovative technology and analytics. Find opportunities to make a difference in a variety of career areas as we all play a role in accelerating health care transformation. Help us deliver cutting-edge solutions for patients, hospitals and insurance companies, resulting in healthier communities. Use your talents to improve the health outcomes of millions of people and discover the meaning behind: Caring. Connecting. Growing together.  

The Case Management Nurse coordinates the team approach to management of patient care on an in-patient as well as outpatient basis. This position works closely with the department manager and the Medical Director to evaluate, monitor and assure the appropriateness and medical necessity of selected care for members as it relates to quality, continuity and cost effectiveness. This position will assist staff in maintaining balance between the needs of the patient, physician, IPA and contracted health plan. This position is responsible for managing utilization and, if necessary, discussing utilization of service and standards of patient management

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

Primary Responsibilities:

• Initiates discharge planning and uses an interdisciplinary process in which all members of the health care team collaborate with patients and their families to anticipate needs. Develop and implement a plan to provide service after discharge
• Review patient’s discharge needs as ordered by physicians and determine medical necessities based on appropriate guidelines
• Facilitates cost effective and quality patient care by effective communication with physicians, providers and members
• Performs on-site or telephone reviews of patient’s charts to determine medical necessity of hospitalization
• Facilitates long-term placement of patients at skilled and custodial levels of care
• Attends Interdisciplinary Clinical rounds with health plans and present patient cases
• Provide telephonic support to members through Ambulatory Case Management Program

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:

• California licensed Registered Nurse or California Licensed Practical Nurse
• 3+ years of experience in a managed care setting and/or recent clinical experience
• Ability to travel up to 10%

Preferred Qualifications:

• Bachelor’s degree
• Ability to prioritize and organize work area despite multi-faceted task directions and interruptions
• Experience and understanding of the confidentiality of medical records
• Thorough understanding of the managed care environment from the perspective of the member, physician, and hospital
• Excellent interpersonal skills with the ability to handle difficult people/situations, as well as interface with physicians, hospital staff, members and health plan in a tactful, informed and customer-oriented manner
• Solid written and verbal communication skills

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.

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

California Residents Only: The salary range for California residents is $56,300 to $110,400. 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.