Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.
Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale.
Caring. Connecting. Growing together.
You’ll enjoy flexibility to work remotely from anywhere within the U.S. while taking on tough challenges.
Primary Responsibilities
Conduct clinical evaluations of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member’s health, social determinants, and gaps in care
Create and implement a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient’s needs and goals
Perform ongoing updates of the care plan to evaluate effectiveness, and to document barriers, interventions, and goal achievement
Partner with primary providers or multidisciplinary team members to align or integrate goals to plan of care
Complete telephonic visits for member engagement and enrollment
Use motivational interviewing to evaluate, educate, support, and motivate change during member contacts
Identify and consider appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
Ensure compliance with quality metrics specific to health plan delegation and accrediting body requirements
Conduct self and peer audits on a regular and assigned timeline
Maintain caseload per defined medical management department standards
Sustain productivity and audit requirements per medical management department standards
Demonstrate ability to work independently and implement innovative approaches to complex member situations
Determine need for continued member management, create care plan and facilitate transition to medical management programs
Attend departmental meetings and provide constructive recommendations for process improvement
Perform other duties as assigned
Required Qualifications
Associate’s Degree in Nursing
Valid multi‑state compact license
Case Management Certification or ability to obtain within 2 years of hire
2+ years of job‑related experience in a healthcare environment
Experience utilizing excellent communication, interpersonal, organization and customer service skills
Knowledge of computer functionality and software applications (e.g., navigating systems, troubleshooting, electronic charting, accessing intranet and record management databases)
Demonstrated knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, commercial) or regulatory bodies (e.g., NCQA)
Understanding of relevant health care benefit plans
Ability to work in Pacific Standard Time
Preferred Qualifications
Bachelor’s degree or higher in healthcare related field
3+ years of experience providing case management and/or utilization review within a health plan or integrated system
Proven self‑motivated, attention to detail
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Pay is based on several factors including local labor market, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $58,800 to $105,000 annually based on full‑time employment.
Application Deadline: This posting will be open at least 2 business days or until a sufficient candidate pool is collected. It may close early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone—of every race, gender, sexuality, age, location and income—deserves the opportunity to live their healthiest life. We are committed to mitigating our impact on the environment and delivering equitable care that addresses health disparities and improves health outcomes.
OptumCare is an Equal Employment Opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
Seniority level
Mid‑Senior level
Employment type
Full‑time
Job function
Health Care Provider
Industry
Nursing Homes and Residential Care Facilities
Referrals increase your chances of interviewing at Optum by 2x.