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Job Details


UnitedHealth Group

RN Case Manager-In-Home Philadelphia, Montgomery and Bucks County

Healthcare

Nurse

No

Philadelphia, Pennsylvania, United States

$5,000 Sign-on Bonus for External Candidates

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)

Serving millions of Medicare and Medicaid patients, Optum is the nation’s largest health and wellness business and a vibrant, growing member of the UnitedHealth Group family. We’re also the career home for Registered Nurses who bring compassion and passion, energy and focus to their work every day. As a Home Visit Registered Nurse with Optum, you’ll provide primary care home visits for patients in collaboration with the physician of record and patient care team.

The Optum Dual Special Needs Plan (DSNP) at Home program is a longitudinal, integrated care delivery program that coordinates the delivery and provision of clinical care of members in their place of residence. The DSNP program combines Optum trained clinicians providing intensive interventions customized to the needs of each individual, in collaboration with the Interdisciplinary Care Team, which includes the Optum clinician, the member’s Primary Care Provider and other providers, and other professionals.

The Field Registered Nurse supports the overall patient care management process for members in In-Home DSNP program. The Field Registered Nurse provides oversight, guidance and support for the patient care plan as developed in collaboration with the interdisciplinary care team along with the health plan and additional heath care vendors to meet the needs of the patient. The Field RN coordinates and provides appropriate levels of care under the direct supervision of an RN/APC or MD. This position is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, in home visit assessments, coordination of care, and medical management consulting. The Field RN will also be responsible for home visits, transition of care management, providing health education, coaching and treatment decision support for members in At Home DSNP program.

Primary Responsibilities:

  • 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:

  • Active, un - encumbered RN license to practice nursing in the state of assignment or ability to obtain
  • Access to reliable transportation that will enable you to travel to client and / or patient 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

Preferred Qualifications:

  • Undergraduate degree or equivalent experience
  • Experience working with complex patient populations including multiple chronic diseases with diverse psychosocial backgrounds
  • Experience working in home health or in home setting
  • Basic knowledge of computers and cell phones
  • Understanding of Medicare, Medicaid and Health Plan benefit structures
  • Bi - lingual or multi - lingual
  • 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


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. 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.

**PLEASE NOTE** The Sign On Bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a Sign On Bonus.

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.

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