**Monday-Friday NO weekends NO holidays NO on-call requirements** **Monday – Friday 8am-5pm** **Ability to travel in the Phoenix Metro area (Northwest-Central Phoenix including Glendale, Deer Valley, Sun City Peoria) using reliable transportation** 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. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** We’re launching an innovative new program aimed at improving care outcomes for high-risk patients. This role is ideal for a Registered Nurse with solid clinical knowledge-particularly in aging populations- who is innovative, engaging, and flexible in adapting to changing needs. You’ll work in the field to support care coordination, assess patient needs and collaborate across interdisciplinary teams. No hands-on care is required. The RN will make strategic visits with a patient after transitioning home from inpatient facilities. **Primary Responsibilities:** + Conduct home visits as indicated for patient engagement/evaluation to identify gaps in care post discharge + Participate in the development and implementation of care coordination with the patient, caregiver(s), primary care provider(s), transitional care manager(s), and/or other appropriate healthcare professionals to address the patient’s needs and goals + Educate the patient and family on community resources, ED alternatives, and/or seeing their primary care provider to provide support and care to decrease readmissions, emergency department utilization + Assess and prioritize case referrals to assure timeliness of engagement and home visit completion within expected time frames + Participate in team meetings, inter-disciplinary meetings, and care conferences via appropriate communication methods + Monitor the effectiveness of the care coordination plan, short/long term needs and adjust per the patient’s needs using clinical judgement + Apply Nursing/Social Work knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function + Coordinate with Behavioral Health Case Manager on cases with a mental health component/need + Proactively investigate and address problems that may contribute to care barriers/non-adherence with the patient + Compile information from workload and other statistical data to prepare reports that demonstrate health care trends within member population + Document patient’s diagnosis, medications, interventions, and observations in electronic medical record/proprietary database in a timely and accurate manner + Advocate for the patient as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team + Utilize advanced clinical skills to make effective and safe decisions to meet the patient’s health, behavioral health and psychosocial needs + Provide coaching, patient education, communication, follow-up care and all available resources to promote quality care support and cost-effective outcomes to enhance adherence to treatment regimen + Keep current in areas of case management, quality management, member education and preventive health guidelines + Assess reports, data, and other health plan information to identify potential members in need of case management intervention + Ability to travel in the Phoenix Metro area (Northwest-Central Phoenix including Glendale, Deer Valley, Sun City, Peoria) using reliable, personal vehicle + Current, unrestricted driver’s license, insurance, and access to reliable transportation that will enable you to travel up to 100% of workday to meet with patients in their home setting + Other duties as assigned 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:** + RN, BSN or above preferred from accredited nursing program + Current unrestricted AZ nursing license + 2+ years- broad-based clinical experience + Proven working knowledge of health care delivery systems + Demonstrated knowledge of EMR, PC applications including MS Office Suite + Ability to travel in the Phoenix Metro area (Northwest-Central Phoenix including Glendale, Deer Valley, Sun City, Peoria) using reliable, personal vehicle for transportation + Driver’s license **Preferred Qualifications:** + Palliative Care experience + Home Health experience + Case management experience + Case management certificate (mandatory after three years of hire) 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 salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. _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._