Optum Home & Community Care, part of the UnitedHealth Group 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. We’re connecting care to create a seamless health journey for patients across care settings. Join us to start **Caring. Connecting. Growing together.** The RN Case Manager monitors real-time ‘Admit, Discharge, Transfer’ (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care. Actively supports ED discharge follow-up care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate next site of care in collaboration with the hospitals/physician team and available outpatient ecosystem resources (PCP, specialist, in-home care, etc.). This position requires a candidate that can be flexible, adapting as the program grows to meet the needs of the populations and markets. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have compact licenses and the ability to obtain other RN non-compact License. **Primary Responsibilities:** + IndependentlycollaborateseffectivelywithEDandoutpatientcareteamstoestablishan individualized transition plan for members + Independentlyservesastheclinicalliaisonwithhospital,clinicalandadministrativestaff and performs transition of care/care coordination for ED discharges using evidenced- based criteria within the documentation system + Performsexpedited,standard,concurrent,andretrospectiveclinicalreviewsatinnetwork and/or out of network facilities + Interactsandeffectivelycommunicateswith EDstaff,members,and theirfamiliesand/or designatedrepresentativetoassessdischargeneeds,formulatedischargeplanandprovide health plan benefit information + Identifiesmember’sEDdischargesupportopportunitieslevelofriskbymonitoringreal- timeADTfeeds and communicates with patient, ED, and outpatient teams for dischargecoordination + ConductstransitionofcareoutreachfollowingEDdischargetoconfirmaccessand completion of discharge plan + Managesassignedcaseloadinanefficientandeffectivemannerutilizingtime management skills + Demonstratesexemplaryknowledgeofutilizationmanagementandcarecoordination processes as a foundation for transition planning activities + Enterstimelyandaccuratedocumentationintodesignatedapplications to comply with documentation requirements and achieve audit scores of 90% or bettermonthly + Records required information into designated program tracker accurately and timely, ensuring proper KPI measurements, achieving audit scores of 90% or better monthly + Adherestoorganizationalanddepartmentalpoliciesandprocedures + Takeson-callassignmentasdirected + TheEDCaseManagerwillalsomaintain currentlicensuretoworkinStateof employment and maintain hospital credentialing as indicated + Decision-makingisbasedonregulatoryrequirements,policyandproceduresandcurrent clinical guidelines + Maintainscurrentknowledgeofhealthplanbenefitsandprovidernetworkincluding inclusions and exclusions in contract terms + Referscasesforadditionalsupport/managementasdeemedappropriate,followingall mandated reporting laws and ethical bounds + Monitorsforanyqualityconcernsregardingmembercareandreportsasperpolicyandprocedure + Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards + Performsallotherrelateddutiesasassigned 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:** + Current,unrestrictedMultistateRNlicense + Must reside in a PST or MST state + 4+yearsofdiverseclinicalexperienceincaringfor acutelyillpatientswithmultiple disease conditions + Knowledgeofutilizationmanagement,quality improvement,anddischargeplanning + KnowledgeableinMicrosoftOffice applicationsincludingOutlook,Word,andExcel + Demonstratedabilitytoread,analyzeandinterpretinformationinmedicalrecords,and health plan documents + Demonstrated abilitytoproblemsolveandidentifycommunityresources + Provenabilityto execute planning,organizing,conflictresolution,negotiatingand interpersonal skills + Provenabilitytoutilizecriticalthinkingskills,nursingjudgement,anddecision-making skills + Provenabilitytoprioritize,plan,andhandlemultipletasks/demandssimultaneously + Ability to providesupport24/7 **Preferred Qualifications:** + ExperienceworkingintheEmergencyDepartment + Experiencewith managed careand/orcasemanagementexperience **Physical** **&** **Mental** **Requirements** : + Abilitytositforextendedperiods oftime + Abilitytostandfor extendedperiods oftime + Abilitytousefinemotorskillstooperateofficeequipmentand/ormachinery + Abilitytoreceiveandcomprehendinstructionsverballyand/or in writing + Abilitytouselogicalreasoningforsimpleandcomplexproblemsolving *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _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._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._