Field RN Case Manager, Optum Care at Home - Milwaukee, WI

About the role

Optum Home & Community Care, part of the Optum family of businesses, is creating an integrated care model that holistically addresses an individual's physical, mental, and social needs — helping patients access and navigate care anytime and anywhere. As a team member of the Optum Care at Home team, you will work in an interdisciplinary care environment to help patients navigate the health care system and connect them to key support services, delivering preventive care that helps patients stay well at home.

The Optum Dual Special Needs Plan (DSNP) at Home program is a longitudinal, integrated care delivery program that coordinates clinical care for members in their place of residence. The program combines Optum-trained clinicians providing intensive, customized interventions in collaboration with the Interdisciplinary Care Team, including the member's Primary Care Provider and other professionals.

The Field Registered Nurse supports the overall patient care management process for members in the In-Home DSNP program. This role provides oversight, guidance, and support for the patient care plan developed in collaboration with the interdisciplinary care team, health plan, and additional health care vendors. The Field RN coordinates and provides appropriate levels of care under the direct supervision of an RN/APC or MD, and is responsible for clinical operations and medical management activities across the continuum of care — assessing, planning, implementing, coordinating, monitoring, and evaluating. This includes case management, in-home visit assessments, coordination of care, and medical management consulting. The Field RN also conducts home visits, transition of care management, and provides health education, coaching, and treatment decision support for members in the At Home DSNP program. This is a field-based position based in Milwaukee, WI.

Responsibilities

• Perform initial review of consumer health records and current health status (e.g., health risk scores) to identify health risk and determine next steps
• Conduct initial and ongoing assessments utilizing nursing assessment skills in home setting
• Receive information from consumers about specific symptoms and questions
• Conduct interviews to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy
• Evaluate consumer data throughout the assessment process to identify inconsistencies and adherence to Evidence Based Guidelines from both the health care and psychosocial/socioeconomic dimensions of care
• Identify and prioritize gaps to develop plan of care and short- and long-term goals to empower consumers to meet identified goals
• Determine consumer's willingness to engage in plan of care and readiness for change
• Identify appropriate interventions and resources to meet gaps (e.g., psychosocial, transportation, long-term care) based on specific consumer needs from both the health care and psychosocial/socioeconomic dimensions of care
• Document the plan of care in appropriate EHR systems and enter data per specified format
• Maintain consumer engagement by establishing rapport, demonstrating empathy, and building a trusting relationship
• Collaborate with primary providers or multidisciplinary team to align or integrate goals to plan of care and drive consistent coordination of care
• Provide ongoing support for advanced care planning
• Reassess plan of care at appropriate intervals based on initial objectives, significant change of condition, or achievement of goals
• Understand and operate effectively/efficiently within legal/regulatory requirements
• Utilize evidence-based guidelines (e.g., medical necessity guidelines, practice standards, industry standards, best practices, and contractual requirements) to make clinical decisions, improve clinical outcomes, and achieve business results

Requirements

• Active, unencumbered RN license
• 3+ years of experience in a hospital, acute care, or direct care setting
• Experience with EMR systems and navigating a Windows-based environment
• Driver's license and access to reliable transportation enabling travel to client and/or patient sites within a designated area

Qualifications

• BSN
• CCM
• Case Management experience
• Experience working in home health or in-home setting
• Experience with chronically ill patients and families
• Understanding of Medicare, Medicaid, and Health Plan benefit structures

Pay

The salary for this role will range from $60,200 – $107,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.

Benefits

• $7,500 Sign-On Bonus for external candidates
• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401(k) contribution

All benefits are subject to eligibility requirements.