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Telephonic Nurse Case Manager RN - Telecommute

UnitedHealth Group

Wausau, WI
Job Code:
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Job Details

Telephonic Nurse Case Manager RN - Telecommute(Job Number:729498)

Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)


The Telephonic Nurse Case Manager RN performs general and high risk, complex Case Management activities across the continuum of care to drive and support proactive quality, cost efficient outcomes and minimize fragmentation of health care delivery. The Complex Case Manager works with consumers, caregivers, and providers focusing on preventing avoidable admission / readmission to hospitals, emergency departments, other facilities and high cost services. The Complex Case Manager leads a collaborative process of assessment, planning, facilitation, and advocacy to meet individual and population health needs.    


The Case Manager functions across the continuum of telephonic Case Management, with the overall goal of activating the consumer to enhance quality of care, to facilitate change in consumer behavior and to promote optimal outcomes for all parties involved.    


This is a telecommute / work from home position where you must live within a commutable distance to one of our offices in the following locations: Richardson TX, Greensboro NC, Lisle IL, St. Louis MO, West Chester OH, Cincinnati OH, Phoenix AZ, & Eden Prairie MN.


Primary Responsibilities:    

  • Conduct initial and follow - up assessments within designated timeframes on patients identified as having highest risk complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial)
  • Assess the patient's current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatment plan
  • Engage patient, family, caregivers, and healthcare providers to assure that a well - coordinated treatment plan is established
  • Utilize holistic approaches to patient care and integrates patient's life and motivational goals into the treatment plan
  • Prioritize care needs, set goals and develop a treatment plan (or plan of care) that also addresses gaps and / or barriers to care and uses evidence - based practice as the foundation
  • Track the patient's health status and progress in achieving clinical and personal goals
  • Provide education, information, direction, and support related to care goals of patients
  • Communicate with patients, families, caregivers, physicians, and other service providers to coordinate the care needs for the patient
  • Work to facilitate patient compliance and to ensure continuity of care
  • Monitor and evaluate the patient's response to treatment(s)
  • Collaborates with internal Medical Directors to attain optimal outcomes and cost efficient services
  • Document assessments, interventions, and follow-up on Case Management activities
  • Regularly assess the effectiveness and quality of services provided to patients by analyzing outcomes (clinical, functional, and financial)
  • Maintain a focus on timely, quality customer service
  • Maintain a focus on the customer service through policy and program decisions and consider impact of these activities on the members
  • Facilitate problem resolution with members, providers, and other agencies or entities as needed
  • Promotes cost efficient health care consistent with adding value for consumers, customers and business
  • Serves as consumer advocate and maintains consumer's privacy, confidentiality and safety
  •  Adheres to ethical, legal / regulatory and accreditation standards
  • Participates in special projects, initiatives, and other job duties as assigned

This position will require active and unrestricted Nursing licensure in multiple US States.  Selected candidate must be willing and able to obtain and maintain multiple state licensure. (Application fees and filing costs paid for by UHG)   

Job Case Management
Primary Location US-WI-Wausau
Other Location US-TX-Richardson, US-IL-Lisle, US-NC-Greensboro, US-OH-West Chester, US-AZ-Phoenix, US-MN-Eden Prairie, US-MO-St. Louis, US-OH-Cincinnati
Organization Optum Ops - PHM UMR
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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