Case Manager RN - Remote in TX, AZ, and CO

$58,300 - $114,300/Yr

Optum - Fort Worth, TX

Full-time - Mid Level

Remote - Fort Worth, TX

Insurance Carriers and Related Activities

About the position

The Case Manager RN at Optum plays a crucial role in driving referral management and facilitating care transitions for high-risk patients. This position involves collaboration with primary care providers, specialists, and clinical pharmacists to ensure coordinated service delivery. The role integrates pharmacy management, care coordination, and utilization management, ultimately aiming to improve health outcomes and advance health equity on a global scale.

Responsibilities

• Work with a Care Team of a Clinical Pharmacist and Clinical Administrative Coordinator to support patient and provider engagement for Care Transitions Management, Care Coordination, and Medication Therapy Management.
• Facilitate inpatient discharge information to Care Team and Primary Care Offices using appropriate technology tools.
• Consult with patients who have had an inpatient discharge; facilitate scheduling transitions of care follow-up appointments with PCP and/or specialists.
• Consult with patients who have had an ED discharge; facilitate scheduling follow-up appointments as needed; review post-discharge information with patients and educate on alternative sites of care.
• Engage high-risk patients telephonically to schedule appointments with Clinical Pharmacist for Comprehensive Medication Reviews.
• Prepare patient cases in workflow management platform for Clinical Pharmacist patient engagement.
• Consult with patients identified as needing a specialist referral to recommend high quality, lower cost specialists.
• Support high-risk patients by scheduling PCP and/or specialist appointments on their behalf.
• Provide benefit information and resources to patients upon request.
• Communicate with provider offices to problem-solve patient issues and/or facilitate communication between practice staff and Care Team.
• Notify PCP and Care Team Clinical Pharmacist of relevant clinical information gathered during calls to patient that may affect the patient's disease state or medication regimen.
• Develop strong relationships with provider offices participating with Practice Extend program by communicating program goals, patient needs, and value-based opportunities.
• Facilitate and/or lead meetings with provider offices for initial onboarding meetings and ongoing collaboration meetings.

Requirements

• Bachelor's Degree (or higher)
• Unrestricted, compact licensure as a Registered Nurse for applicable states within our program
• 4+ years of Case Management and/or Care Coordination experience
• 3+ years of experience in managing populations with complex medical or behavioral needs
• Intermediate level of proficiency with Microsoft Office, Outlook, and Teams applications and ability to quickly learn clinical applications and multi-system management
• Intermediate level of ability to type and navigate a Window-based environment simultaneously
• Able to travel up to 10% to local office(s) to accommodate business needs
• Ability to work a flexible schedule, including evenings up to 7pm, to accommodate business needs.

Nice-to-haves

• Spanish/English Bilingual
• Prior experience in managed care and/or population health management
• Background in healthcare setting with an understanding of chronic conditions and best practices
• Ability to provide proactive clinical feedback to enhance quality patient engagement and program growth.

Benefits

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life & AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)