Remote Utilization Review Rn Jobs in Poughkeepsie, NY

Optum NY, is seeking an RN Case Manager to join our team anywhere within the U.S. Optum is a clinician-led care organization that is changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.
At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
The RN Case Manager role, operating under general administrative direction, is primarily responsible for coordinating referrals from physicians and healthcare facilities for high-risk members. This position involves significant member education related to their illnesses and planned treatments. The Case Manager supports various Case Management and Quality Improvement programs, ensuring timely communication between members, providers, and health plans. Additionally, the role includes maintaining grievance files and associated documentation.
The overarching goal of the Case Manager is to identify, coordinate, and provide appropriate levels of care while managing clinical operations and medical management activities across the continuum of care. This includes assessing, planning, implementing, coordinating, monitoring, and evaluating care. The role also encompasses health education, coaching, and treatment decision support for members, requiring a Registered Nurse (RN) qualification.
The Case Manager plays a critical role in bridging the gap between healthcare providers, members, and health plans, ensuring that high-risk members receive comprehensive, coordinated, and high-quality care. The position requires strong clinical expertise, excellent communication skills, and a commitment to improving healthcare delivery.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:

• Member Care Coordination
  • Collaborates with physicians and multidisciplinary teams to develop and maintain up to date, coordinated care plans
  • Acts as a liaison between members and the healthcare team to ensure effective communication and alignment of care plans
• Member Referral Support
  • Assists physicians, members, and families in obtaining referrals to specialists
  • Provides counseling and support tailored to the clinical needs of the member
• Care Plan Development
  • Partners with designated physicians to create and maintain individualized Member Care Plans
• Clinical Improvement
  • Actively participates in developing and deploying Coordination of Care activities aimed at enhancing the clinical experience for both referred members and referring physicians
• Liaison Role
  • Facilitates communication among care team members to address the needs of both the member and the physician
• Provider/Member Education
  • Educates members and care team participants about available community and health plan benefits and services

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:

• Bachelor of Science in Nursing (BSN), or 5+ years case management experience in lieu of BSN
• Unrestricted current RN licensure in state of New York
• 3+ years of diverse clinical experience as a Registered Nurse; preferably in caring for the acutely ill members with multiple disease conditions
• 2+ years of experience in health plan case management, complex and disease case management
• Experience in a remote and telephonic role
• Proficient in Microsoft Office and Adobe products

Preferred Qualifications:

• BSN
• Commission for Case Manager Certification (CCMC)
• Experience in discharge planning
• Experience in utilization review, concurrent review, or risk management
• Background in managed care

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, 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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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.
UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.