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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Research member benefits and eligibility

• Completes all assigned cases within required timeframes (TAT)

• Processes and documents all case activities per SOPs and DES

• Prepares and documents clinical case review and assigns to Medical Director for Medical Director (LTAC, AIR and SNF) decision

• Approves SNF cases where RN’s clinical review indicates that member’s condition meets clinical criteria

• Approves SNF cases where an LPN’s clinical review indicates that member’s condition meets clinical criteria

• Communicates and documents Medical Director determinations to providers and members

• Maintains communications with providers for continuity of care and completion of ALOC requests

• Prepares case information for assignment to National Letter Team

• Submits requested Contract Exceptions for SNF cases

• Educates providers, members and internal staff on guidelines, member benefits, alternate levels of care available

• Acts as a clinical resource to LPNs, PTs, and Non-Clinical staff

• Collaborates with other internal stakeholder’s/departments for member’s appropriate level of care: Medical Director, Optum/United Nursing Home members, Appeals and Grievances, National Letter team, and Intake/CDU

• Performs self-audits to assure compliance with SOP DES

• Works within HSR, InterQual, and multiple SharePoint sites

• Participates in compliance meetings, process improvement planning

• Reports individual case concerns to manager, Medical Director as needed

• Triage cases received from IPC

• Assign cases to Facility ICM or other work groups

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:

• High School Diploma / GED (or higher)

• RN license/certificate

• 3+ years of experience in Case Management, UM preferred

Preferred Qualifications:

• Case management certification and/or experience

• Experience in discharge planning and/or chart review

• Experience in acute long-term care, acute rehabilitation, or skilled nursing facilities

• Experience in utilization review for an insurance company or in a managed care environment

Telecommuting Requirements:

• Have a dedicated work area established that is separated from other living areas and provides information privacy

• Ability to keep all company sensitive documents secure (if applicable)

• Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

• Solid computer skills

• Solid communication skills, written and verbal

• Ability to build and maintain relationships will be essential

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

California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down 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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.