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Telephonic Nurse Case Manager RN Specialist

1 month ago

Buffalo, New York, United States UnitedHealth Group Full time
Company Overview

Optum, a global organization, delivers care and utilizes technology to support the health and well-being of millions worldwide. By working with our team, you will contribute to improving health outcomes by connecting individuals with necessary care, pharmacy benefits, data, and resources.

Salary Range

The estimated annual salary for this role is between $58,300 to $114,300 in New York, reflecting various factors including education, experience, certifications, and location.

Job Description

Key Responsibilities:

  • Conducting outbound calls to assess members' current health status
  • Identifying gaps or barriers in treatment plans
  • Providing patient education to enhance self-management
  • Interacting with Medical Directors on complex cases
  • Coordinating care for members
  • Making referrals to outside sources
  • Coordinating services as needed (e.g., home health, DME)
  • Documenting and tracking findings
  • Utilizing Milliman criteria to determine appropriate hospital settings
  • Making 'welcome home' calls to ensure discharged members receive necessary services and resources
Required Skills and Qualifications

To be successful in this role, you must possess:

  • An active, unrestricted RN license in the State of New York
  • Multiple state licensure (in addition to Compact License if applicable) OR the ability to obtain multiple state nursing licenses
  • A minimum of 3 years of RN experience in a hospital setting, acute care, direct care, or as a Case Manager at an insurance company
  • Proficiency in computer applications, including MS Outlook, Word, and navigating a Windows environment
  • Ability to work Monday - Friday: 3 days/week 8 am - 5 pm and 2 days/week 11 am - 8 pm
  • Willingsness to work onsite in the Cheektowaga, NY office for the first 6-12 months
  • Access to secure, high-speed internet and a dedicated workspace at home
  • Residency in New York
Benefits

We offer a comprehensive benefits package, incentive programs, equity stock purchase, and a 401k contribution program, all subject to eligibility requirements.