RN Case Manager - SNF - Remote in Utah

Optum UT is seeking a Skilled Nursing Facility (SNF) Case Manager to join our team in Draper, UT. 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 in improving healthcare through the power of people and intelligent technologies while Caring. Connecting. Growing together. 

The Skilled Nursing Facility (SNF) Case Manager is responsible for coordinating and managing care for Medicare Advantage members admitted to skilled nursing facilities. This role collaborates with facility staff, providers, members, caregivers, and interdisciplinary teams to support safe transitions of care, improve member outcomes, reduce avoidable hospital readmissions, and promote appropriate skilled nursing facility length of stay through proactive care coordination and case management interventions. This position serves as a key liaison between the health plan, facility partners, providers, members, and caregivers to ensure timely, effective, and member-centered care. The SNF Case Manager plays a critical role in mitigating financial and quality risks to the organization.

Candidate must live and possess an active and unrestricted Utah RN license

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

Position Highlights & Primary Responsibilities:

• Manage a caseload of Medicare Advantage members admitted to skilled nursing facilities
• Develop, implement, and monitor individualized care plans based on member needs, goals, and available resources
• Collaborate with SNF staff, physicians, advanced practice providers, therapists, caregivers, and interdisciplinary teams to coordinate care and support positive outcomes
• Participate in interdisciplinary care conferences and discharge planning meetings
• Monitor member progress toward established goals and identify opportunities to improve quality, efficiency, and member experience
• Facilitate safe transitions between care settings, including discharge to home, assisted living, community-based services, or other appropriate levels of care
• Collaborate with Community Health Workers and interdisciplinary team members to address social determinants of health and barriers impacting care
• Complete documentation accurately and within established timelines and regulatory requirements
• Maintain knowledge of Medicare guidelines, post-acute care services, community resources, and care management best practices
• Comply with all organizational, regulatory, privacy, and compliance requirements
• Facilitate timely primary care, specialty care, and post-discharge follow-up appointments
• Maintain accurate, timely, and complete documentation in accordance with organizational, regulatory, and accreditation requirements
• Adhere to all applicable policies, procedures, HIPAA regulations, and quality standards
• Participate in performance improvement, care coordination, and population health initiatives designed to improve member outcomes and reduce healthcare utilization
• Perform other duties as assigned

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: 

• Current, unrestricted Registered Nurse (RN) license in Utah 
• 3+ years of clinical nursing experience, preferably in acute care, care management, case management, utilization management, discharge planning, or transitional care
• Experience working within managed care, Medicare Advantage, value-based care, care management, or population health environments
• Demonstrates case management knowledge and ability to independently assess member needs, develop care plans, prioritize interventions, and manage complex cases with minimal supervision
• Demonstrated solid clinical assessment, critical thinking, problem-solving, and decision-making skills
• Demonstrated excellent written, verbal, and interpersonal communication skills
• Proven ability to collaborate effectively with providers, hospitals, skilled nursing facilities, Community Health Workers, and interdisciplinary care teams
• Demonstrated proficiency with electronic medical records, case management systems, and Microsoft Office applications

Preferred Qualifications: 

• Bachelor's degree in nursing (BSN)
• Case Management Certification (CCM, ACM-RN, or equivalent)
• Experience supporting transitions of care, readmission prevention, post-acute care management, or emergency department utilization programs
• Demonstrated knowledge of community resources and social determinants of health
   

Key Performance Indicators 

• Completes timely assessments and care plan development for assigned members
• Meets outreach and engagement goals for assigned SNF members
• Facilitates timely and appropriate discharge planning activities
• Supports reduction of avoidable hospital readmissions and emergency room utilization
• Maintains productivity and caseload management standards
• Completes documentation accurately and within established timelines
• Collaborate effectively with facility partners and interdisciplinary teams
• Supports member satisfaction, quality, and care coordination goals
• Identifies and addresses barriers impacting member outcomes and transitions of care
• Meets productivity and quality performance standards
• Contributes to improved member outcomes and care experience

*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 salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.