RN Case Manager - HouseCalls - Remote - EST or CST - Compact license Required

100% Remote 

Must be able to adhere to a 9am to 5:30pm EST or CST schedule

Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Optum HouseCalls team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. We're connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.

We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come

The HouseCalls Clinical Support Team (HCCST) supports Advanced Practice Clinicians in the HouseCalls business by providing telephonic consultation to plan members post HouseCalls visit. This position is completely telephonic in a call center environment. Goals of the program include providing a one-time outreach to members for follow up post HouseCalls visit to provide education and clarification on any concerns raised during their HouseCalls visit. The main objective of this program is to ensure successful transition of care from the HouseCalls Advanced Practice Clinician back to the members Primary Care Provider.

This team includes nurse care managers and social workers. The Nurse Care Manager (NCM) will report directly to the Manager/or Director of Clinical Operations of HCCST. The NCM interacts via telephonic consult with members and providers to assist with education and clarification on any concerns raised during the HouseCalls visit and ensure the member has/or assist in obtaining an appointment with the provider to transition care. They work to ensure members receive quality customer service by answering questions, addressing concerns, providing education, providing resource information, and entering referrals.  

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

Primary Responsibilities:

• Perform telephonic outreach to members identified by the Advance Practice Clinician for specific referral related issues
• Ensure member has scheduled appointment with Primary Care Provider (PCP)/specialty provider; help scheduling appointment, if needed
• Refer members to internal departments such as Social Work, or Clinical Help Desk when appropriate
• Gather clinical information telephonically from patient/family
• Assist patients/members with urgent needs requiring acute intervention that arise during the call
• Identify triggers for hospitalization and barriers to meeting healthcare goals as they arise during the call
• Complete required documentation in compliance with auditing standards and policies
• Provide patient/family education on disease process and trigger management that arise during the call or are related to referral reasons
• Assist with connections to appropriate community resources if needed
• Understand and maintain confidentiality of legal and ethical issues
• Maintains compliance with all HIPAA (Health Insurance Portability and Accountability Act) regulations
• Enhance the experience of both internal and external customers by providing excellent customer service while maintaining production metrics
• Serving as a clinical resource and consultant for other clinicians
• Attend and participate in team huddles and staff meetings
• Collaborating with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies
• Provide cross-coverage support across the team and assist with special projects, as needed
• Assume other duties as assigned and directed by the Supervisor or Manager of Clinical Call Center Operations

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