Nurse Case Manager

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.

As a team member of our Landmark product, we help bring home-based medical care to complex, chronic patients. This life-changing work helps give older adults more days at home.

We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.

The Nurse Care Manager (NCM) is an integral part of the Interdisciplinary care team (IDT) and is responsible for the overall care management process for high acuity engaged Landmark patients. The NCM has oversight for developing, managing, and coordinating patients’ plan of care to include medical and psychosocial needs and patient-centered goals. The NCM works with patients/caregivers to maintain and improve health status by providing care coordination, health education, guidance and support for medical and psychosocial complex chronic conditions. Professionals in this role elicit input from the IDT based on initial and ongoing comprehensive assessments of the patient.

The NCM uses nursing assessment, evaluation skills, data and reports to guide care planning decisions for the patient. They are skilled at navigating the patients’ health plan benefits to identify providers, resources and vendors that provide required care and services. The NCM works collaboratively with the IDT to provide appropriate, effective, high quality, and cost-effective care to engaged patients in their current residence. If a patient requires care outside their residence, the NCM collaborates with community-based service providers to ensure coordinated care during critical times of transition between health care settings and home.

In addition to the NCM, the Landmark IDT consists of the Regional Medical Director, Pod Leaders, mid-level practitioners, Health Services Director (HSD), clinical supervisors, behavioral health clinicians, social workers, pharmacists, dietitian/nutritionist, ambassadors, care coordinators, the patient and/or caregiver and family.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Nurse Case Managers will supporting patients in PA, MD, DE and VA.

Primary Responsibilities:

• Acts as an advocate for the patient
• Engages and collaborates with patient/caregiver and providers to develop an individualized Care Plan that addresses disease management, health promotion, and patient-centered goals
• Monitors patient progress against Care Plan goals with an emphasis on patient care needs during times of transition in care setting and changes in health status
• In a Delegated Case Management market, understands and adheres to regulatory timeframes and standards required by National Committee for Quality Assurance (NCQA)
• Provides disease management, health promotion and prevention education to patients/caregivers and/or family members to manage disease progression and encourage proper medical testing, so patient can remain as independent as possible
• Completes initial and ongoing patient assessment, using information gathered from patient/caregiver/family, providers, Landmark EMR, and available medical records
• Ability to manage and coordinate care and services within an Interdisciplinary Team
• Manage incoming clinical calls to ensure patients’ medical concerns are addressed by the care team in a timely manner
• Comfortable having and documenting advance directive conversations with patient/caregiver and/or family, and collaborate to reconcile patient/caregiver goals with the current clinical status
• Coordinates care needs across the continuum of care and is the point of contact for patient/caregiver and clinicians
• Leads daily IDT Huddle
• Actively participates in Landmark meetings and education sessions
• Acts as liaison between providers, nursing facilities, hospitals and program staff, including making recommendations about care alternatives
• Facilitates/coordinates admission to a recommended level of care on a temporary or permanent basis
• Promotes patient safety. Reviews or initiates a home safety, functional assessment, and/or falls risk assessment with home-based providers to determine need for adaptive equipment. Assists with acquisition of assistive equipment, as recommended
• Monitors patient during admissions and provides nursing/assisted living facility and provider training on Landmark program philosophy and approach to patient care
• Identifies and reports any potential quality-of-care issues to Clinical Supervisor/HSD, so a plan of improvement can be developed and implemented, as needed
• Maintains HIPAA compliance at all times

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• RN License in PA, DE, VA or MD, RN License must be current, active, unrestricted and unencumbered
• 1 + years of case management experience or clinical practice experience in a hospital, home care, hospice, clinic or nursing home setting
• Electronic Medical Record documentation experience
• Proficient in patient-centered Care Plan creation and active management
• Computer skills: internet navigation, Microsoft Office - Outlook, Word and Excel

Preferred Qualifications:

• BSN
• 1+ years of Utilization Management experience
• Case Management experience
• Disease state management experience with solid ability to educate patients on health and wellness
• Population Health management experience
• Ability to manage a patient caseload using data and reports

• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $58,300 to $114,300 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.