Senior Case Manager RN, Team Lead

UnitedHealth Group - Richardson, TX

Full-time - Mid Level

Onsite - Richardson, TX

Insurance Carriers and Related Activities

About the position

The Senior Case Manager RN, Team Lead position at Optum involves overseeing escalated cases, mentoring staff, and ensuring optimal patient care through effective communication and coordination with vendors and medical directors. This role is pivotal in enhancing health outcomes by providing education, assessing health statuses, and facilitating necessary services for members. The position also serves as a stepping stone for those interested in advancing to a Clinical Manager role.

Responsibilities

• Serve as a mentor and coach to staff case managers
• Handle escalated cases from team
• Interact directly with vendors and account management
• Make outbound calls to assess members' current health status
• Identify gaps or barriers in treatment plans
• Provide patient education to assist with self-management
• Interact with Medical Directors on challenging cases
• Coordinate care for members
• Make referrals to outside sources
• Coordinate services as needed (home health, DME, etc.)
• Educate members on disease processes
• Encourage members to make healthy lifestyle changes
• Document and track findings
• Make post-discharge calls to ensure that discharged members receive the necessary services and resources

Requirements

• Current, unrestricted RN license in the State of Residence
• Willingness and ability to obtain additional licensures as needed
• Ability to obtain CCM within 24 months of assuming role
• 3+ years of RN experience in a hospital setting, acute care, direct care experience
• 1+ years of experience as a Case Manager in a managed care setting
• 1+ years of demonstrated leadership background
• Computer proficiency, including strong data entry skills and the ability to navigate a Windows environment

Nice-to-haves

• BSN or Masters degree
• Medical / Surgical, Home Health, Diabetes or Cardiac experience (certification in one of those specialties)
• Experience in managed care
• Disease management experience
• Experience / exposure with discharge planning
• Bilingual (Spanish / English) skills

Benefits

• Comprehensive benefits package
• Career development opportunities
• Diversity and inclusion culture