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Optum is seeking a Nurse Case Manager to join our Home-based Medical Care team in Albany, NY. Optum is a clinician-led care organization, that is creating a seamless health journey for patients across the care continuum.

As a member of the broader Home and Community Care team, you’ll help bring home-based medical care to complex, chronic patients. This life-changing work helps give older adults more days at home.

At Optum, the integrated medical teams who practice within Home and Community Care are creating something new in health care. Together, we are bringing high-end medical service, compassionate care and industry leading solutions to our most vulnerable patient populations. Our holistic approach addresses the physical, mental and social needs of our patients wherever they may be - helping patients access and navigate care anytime and anywhere. We’re connecting care to create a seamless health journey for patients across care settings. Join our team, it’s your chance to improve the lives of millions while 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 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 HbMC IDT includes but not limited to, physicians, nurse practitioners, physician assistants, nurse care managers, behavioral health clinicians, social workers, pharmacists, dietitian/nutritionists, ambassadors, care coordinators, the patient and/or caregiver and family.

If you are located in Albany, NY, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Actsasanadvocateforthepatient

• 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 patientprogress againstCarePlangoals withanemphasisonpatient care needsduring times of transition in care setting and changes in health status

• Identifiesbarrierstoachieving CarePlangoalsand collaborates withpatient/caregiveraswellas IDT to overcome barriers to success

• UnderstandsandadherestoregulatorytimeframesandstandardsrequiredbyNationalCommittee forQuality Assurance (NCQA)within a Delegated Case Managementmarket and Dual& Chronic Special Needs Plans (SNP)

• Providesdiseasemanagement,health promotionandpreventioneducation topatients/caregivers and/or family patients to manage disease progression and encourage proper medical testing, so patient can remain as independent as possible

• Completes initialandongoingpatientassessment,usinginformationgatheredfrom patient/caregiver/family, providers, HbMC EMR, and available medical records

• ManagesandcoordinatescareandserviceswithinanInterdisciplinaryTeam

• Manages incoming clinical calls to ensure patients’ medical concerns are addressed by the care team in a timely manner

• Participatesin and documentsadvancedirective conversationswithpatient/caregiverand/or family, and collaborates to reconcile patient/caregiver goals with the current clinical status

• Coordinatescareneedsacrossthecontinuumof careand isthe pointof contact for patient/caregiver and clinicians

• LeadsdailyIDT Huddle

• ActivelyparticipatesinHbMCmeetingsandeducationsessions

• Actsas liaisonbetweenproviders,nursingfacilities,hospitalsandprogram staff, includingmaking recommendations about care alternatives

• Facilitates/coordinatesadmission toa recommended levelof careon atemporaryorpermanent basis

• Promotespatient safety. Reviewsorinitiates ahomesafety, functionalassessment, and/orfalls risk assessment withhome-basedproviders todetermine needforadaptiveequipment. Assists with acquisition of assistive equipment, as recommended

• Monitors patientduringadmissionsandprovidesnursing/assisted living facilityandprovider training on HbMC program philosophy and approach to patient care

• Supportspatientsduring transitionsof carethroughassessment,coordinationof care, education of the plan of care and evaluation of the effectiveness of the plan

• Identifiesand reports anypotentialquality-of-care issuestoClinicalSupervisor/HSD, soaplanof improvement can be developed and implemented, as needed

• At times,the NCMmayvisitapatient intheirhomeforeducationorassessment, Market/State dependent

• MaintainsHIPAAcomplianceatalltimes

Supervisory:

• ReportsdirectlytotheHealthServicesManager

Competencies:

• Problem Solving - Identifies and resolves problems in a timely manner; gathers and analyzes information skillfully utilizing critical thinking skills; develops alternative solutions; works well in group problem solving situations; uses reason even when dealing with emotional topics

• Customer Service - Manages difficult or emotional customer situations; responds promptly to customer needs; solicits customer feedback to improve service; responds to requests for service and assistance; meets commitments

• Interpersonal Skills -Focusesonsolvingconflict;maintainsconfidentiality;listenstoothers;keeps emotions under control and overcomes resistance when necessary; remains open to new ideas

• Oral Communication - Speaks clearly andpersuasively in positive ornegative situations; listens and seeksclarification; respondsopenlyto questions.Mustbeable to dealwith frequent change, delays, or unexpected events

• Attendance/Punctuality - Is consistently at work and on time; ensures work responsibilities are covered when absent; arrives at meetings and appointments on time

• Dependability - Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments; commitsto long hoursof work when necessaryto reach goals; completes tasks on time or notifies appropriate person with an alternate plan

• Initiative - Volunteers readily; undertakes self-development activities; seeks increased responsibilities; takes independent actionsand calculated risks; looksfor and takes advantage of opportunities; asks for and offers help when needed; generates suggestions for improving work and workflow

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:

• New York state nursing license required

• RNLicensemust becurrent, active, unrestricted and unencumbered

• 3+yearsofclinicalpracticeinahospital,homecare,hospice,clinic,ornursinghomesetting

• ElectronicMedicalRecorddocumentationexperience

• Proficientinpatient-centeredCarePlancreationandactivemanagement

• Computerskills:internetnavigation,MicrosoftOffice-Outlook,WordandExcel

Preferred Qualifications:

• BSN

• CaseManagementexperienceandCCMCertification

• 1+yearsofUtilizationManagementexperience

• Diseasestatemanagementexperiencewithsolidabilitytoeducatepatientsonhealthand wellness

• PopulationHealthmanagementexperience

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

New York Residents Only: The salary range for this role is $58,300 to $114,300 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.

Diversity creates a healthier atmosphere: OptumCare 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.

OptumCare i s a drug-free workplace. Candidates are required to pass a drug test before beginning employment.