Complex RN Case Manager, Optum Network of Connecticut

3 days ago


Somers, Connecticut, United States Optum Full time
Opportunities with Optum Network of Connecticut

As a RN Case Manager with Optum Network of Connecticut, you will play a vital role in sustaining the health and well-being of our community. Our team is dedicated to delivering exceptional care and service, and we are seeking a skilled and compassionate professional to join our ranks.

Position Details
  • Location: Telecommuter position, with occasional travel to Farmington, CT for training and meetings
  • Department: Case Management
  • Schedule: Full-time, 40 hours/weekly, Monday through Friday, 8:00AM - 4:30PM
Responsibilities
  1. Member Care Coordination: Work closely with physicians to coordinate care plans and communicate with the healthcare team on behalf of the member
  2. Member Referral Support: Assist physicians, members, and their families in obtaining referrals to needed specialists, providing support and counseling as needed
  3. Care Plan Development: Work with designated physicians to develop and maintain member care plans
  4. Clinical Improvement: Participate in the development and deployment of coordination of care activities to improve the clinical experience for referred members and the referring physician
  5. Liaison: Communicate with members of the care team to coordinate the identified member and physician's needs
  6. Provider/Member Education: Educate members and care team participants on community/health plan benefit services available
Requirements
  • Bachelor's Degree in Nursing (BSN)
  • Unrestricted current CT Nursing License
  • 2+ years of experience managing complex disease states
  • 2+ years of telephonic health plan case management
  • Experience with Electronic Health Records (Allscripts, Epic)
  • Knowledge and understanding of NCQA/ACO/CDO regulations and standards
  • High proficiency with navigating multiple complex computer programs (including but not limited to Microsoft Products, Adobe)
  • Ability to travel up to Farmington, CT for training and meetings as needed
Preferred Qualifications
  • Master's Degree in Nursing (MSN)
  • Certified Case Manager Certification (CCMC)
  • 5+ years of experience as a nurse case manager
  • 5+ years of experience managing complex disease states
  • 2+ years of utilization management or concurrent review experience
  • Experience in a remote work setting
  • Bilingual with English and Spanish, Polish, Mandarin, or Vietnamese


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