Senior RN Case Manager - Remote

Senior RN Case Manager – Fishkill, NYJob Overview This position is responsible for clinical operations and medical management activities across the continuum of care, including case management, coordination of care, medical management consulting, health education, coaching, and treatment decision support. The role coordinates and supervises daily activities of the business support, technical, or production team or unit.Remote flexibility: You have the option to work remotely from anywhere within the United States, while remaining based in Fishkill, NY.Key ResponsibilitiesMaintain caseloadReviews the work of othersDevelops innovative approachesCoordinates work activities with supervisors and/or managersServe as a clinical resource, coach for Complex Case, Disease, and Transitional Case ManagementManage programs, and ED Follow-upAct as primary preceptor for RN and LPN Case ManagersAssign and support preceptor for all other rolesSupport and maintain relationships with affordability and vendor programs, including palliative care, continuum/fee for services programs, and patient care conferencesAnticipate customer needs and proactively develop solutionsServe as a key resource on complex and/or critical issuesResolve complex problems and develop innovative solutionsPerform complex conceptual analysesReview work performed by others and provide recommendations for improvementForecast and plan resource requirementsAuthorize deviations from standardsLead functional or segment teams or projectsProvide explanations and information to others on the most complex issuesMotivate and inspire team membersConduct call monitoring and case auditing of staff; implement performance improvement plansWork in a fast‐paced environmentFacilitate the complaint process by engaging members, families, and caregivers telephonicallyEstablish a process for member education to assist with self‐management goals, disease management, or acute conditionUtilize evidence‐based practice to develop interventionsEstablish a process to utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacyManage the quality of clinical assessments and Care PlansCoordinate regular clinical reviews of high‐risk cases with members of the Interdisciplinary Care Team (IDCT)Ensure adherence to relevant state and federal guidelines and regulatory bodies for Complex Case, Disease and Transitional case managementDemonstrate understanding of utilization management processesMaintain in‐depth knowledge of company products and services as well as customer issues and needsMonitor staff caseload efficiently to ensure optimal productivityMonitor and ensure timely and accurate documentation in the care management electronic software system to comply with documentation requirements and achieve audit scores of 95% or better monthlyAttend meetings and participate in committees as requestedIdentify opportunities for process improvement in all aspects of member careSupport data collection and closing of care gaps and quality metrics as assigned; assist healthcare team in meeting quality metricsMaintain strict confidentialityAdhere to all department/organizational policies and proceduresPerform all other related duties as assignedRequired QualificationsCurrent, unrestricted RN license in both New York and New JerseyBachelor of Science in Nursing (BSN)Associate of Science in Nursing5+ years of diverse clinical experience; preferred in managed care (delegated medical management), Complex Case Management, Disease Management and Transitional Case Management2+ years of diverse clinical experience, preferably in managed care, Complex Case Management, Disease Management and Transitional Case ManagementProven expert knowledge of case management principles, evidenced by certification in Case Management (CCM) or willingness to obtain within 12 months of employmentProven knowledge of relevant state and federal guidelines and regulatory bodiesPeople‐management experience, including motivational leadership, ability to implement performance improvement plans, and drive to see employees succeedExperience managing direct reports to performance metricsProficient with Microsoft Office and Adobe productsRemote work experiencePreferred Qualifications5+ years of managed care, Complex Case Management experience1+ years of recent leadership experience with ability to build high‐performing teamsDisease Management and Transitional Case Management experienceKnowledge of utilization management, quality improvement, and discharge planningAbility to cultivate a solid internal culture designed around collaboration, feedback, motivation, and accountabilitySolid communication and interpersonal skillsDemonstrated ability to work in a fast‐paced, multi‐tasking team environment while meeting deadlinesHighly skilled in leading change efforts and building partnerships with business‐line executivesAbility to summarize complex issues and problems into concise reports focused on key findings and outcomesAbility to consistently manage up and downAbility to complete initiatives with minimal supervisionProficiency in developing communication strategies for a wide array of audiences that support strategic objectivesDemonstrated sophisticated written and verbal presentation abilities; experience with developing presentation materialsProven proficiency in time management, flexibility, and influencing colleagues to meet demanding timelinesSalary & Benefits Salary range: $72,800 to $130,000 annually for full‐time employment. Benefits include a comprehensive package, incentive and recognition programs, equity stock purchase program, and 401(k) contribution. Eligibility requirements apply.Equal Opportunity OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.Drug‐Free Workplace OptumCare is a drug‐free workplace. Candidates are required to pass a drug test before beginning employment.#J-18808-Ljbffr