RN Case Manager

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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.^SM

We're making a strong connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path?

Schedule: Monday - Friday 8:00 am - 5:00 pm

If you are located in the Nashville, TN area, you will enjoy the flexibility of a hybrid-remote role as you take on some tough challenges.

Primary Responsibilities:

• Provides care coordination through physician practices for members to improve clinical quality and clinical documentation


• May conduct telephonic member needs assessments according to state and national guidelines, policies, procedures, and protocols


• May interact with members via telephone; Schedule appointments, Follow-up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed that relate to preventative health screenings or HEDIS gaps in care


• Review member charts prior to a physician appointment and create alerts/triggers to highlight Star opportunities for the practice


• Partner with the practice's administrative and clinical staff while managing member appointments and data between visits


• Create and maintain a professional and supportive relationship with the member, provider and office staff


• Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness and Social Services


• Assists the member to access community, Medicare, family and other third-party resources as appropriate


• Collaborates and communicates with the member's health care and service with our interdisciplinary delivery team to coordinate the appointments, screening or care related to preventative health screenings or HEDIS gaps in care


• Provides education to members regarding health care needs and available services related to preventative health screenings or HEDIS gaps in care


• Works to facilitate member compliance with their appointments, screenings, medications and/or action plans to complete open care opportunities/HEDIS gaps in care


• Identifies barriers for compliance in preventative health screenings or HEDIS gaps in care and communicates with members and providers to formulate action plan to address


• Documents member conversations and activities in Optum/UHC programs. No documentation in provider EMRs and/or member charts


• Maintains a focus on timely, high-quality customer service


• Maintains the confidentiality of all sensitive information

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays


• Medical Plan options along with participation in a Health Spending Account or a Health Saving account


• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage


• 401(k) Savings Plan, Employee Stock Purchase Plan


• Education Reimbursement


• Employee Discounts


• Employee Assistance Program


• Employee Referral Bonus Program


• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)


• More information can be downloaded at:

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:

• Associates Degree (or higher) in Nursing


• Current, unrestricted RN license in the State of TN


• 3+ years of clinical experience in a hospital, acute care, home health, direct care, or case management


• Intermediate level of computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications including MS Office and Excel


• Reliable transportation, valid and unrestricted driver's license, proof of insurance and ability to travel to provider offices or other locations within service delivery area, may require up to 1-hour radius for travel


• Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

• Bachelor of Science (or higher) in Nursing


• Case Management experience including Certification in Case Management


• Experience with HEDIS and EMR (electronic medical records)


• Experience with navigating and analyzing reports in Microsoft Excel


• Medicaid, Medicare, Managed Care experience


• Physician Office experience


• Home care/field-based case management


• Experience in intensive care (ICU), emergency department (ER) nursing, or Home Health


• Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs


• Call Center experience

Soft Skills:

• Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action


• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others


• Ability to identify with a consumer in order to understand and align with their needs and realities


• Ability to perform effective active listening skills to empathize with the customer in order to develop a trust and respect


• Ability to take responsibility and internally driven to accomplish goals and recognize what needs to be done in order to achieve a goal(s)


• Ability to turn situations around and go above and beyond to meet the needs of the customer

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged, and high-performing teams to help solve important challenges.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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.

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