RN Care Coordinator or Case Manager ED - Remote

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.Is this your next job Read the full description below to find out, and do not hesitate to make an application.The RN Case Manager monitors real-time 'Admit, Discharge, Transfer' (ADT) notifications to provide proactive patient and provider outreach and discharge coordination to support optimal transitions of care. Actively supports ED discharge follow-up care utilizing approved clinical guidelines to transition and provide continuity of care for members to an appropriate next site of care in collaboration with the hospitals/physician team and available outpatient ecosystem resources (PCP, specialist, in-home care, etc.). This position requires a candidate that can be flexible, adapting as the program grows to meet the needs of the populations and markets.You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have compact licenses and the ability to obtain other RN non-compact License.Primary Responsibilities:Independently collaborates effectively with ED and outpatient care teams to establish an individualized transition plan for membersIndependently serves as the clinical liaison with hospital, clinical and administrative staff and performs transition of care/care coordination for ED discharges using evidenced- based criteria within the documentation systemPerforms expedited, standard, concurrent, and retrospective clinical reviews at in network and/or out of network facilitiesInteracts and effectively communicates with ED staff, members, and their families and/or designated representative to assess discharge needs, formulate discharge plan and provide health plan benefit informationIdentifies member's ED discharge support opportunities level of risk by monitoring real- time ADT feeds and communicates with patient, ED, and outpatient teams for discharge coordinationConducts transition of care outreach following ED discharge to confirm access and completion of discharge planManages assigned case load in an efficient and effective manner utilizing time management skillsDemonstrates exemplary knowledge of utilization management and care coordination processes as a foundation for transition planning activitiesEnters timely and accurate documentation into designated applications to comply with documentation requirements and achieve audit scores of 90% or better monthlyRecords required information into designated program tracker accurately and timely, ensuring proper KPI measurements, achieving audit scores of 90% or better monthlyAdheres to organizational and departmental policies and proceduresTakes on-call assignment as directedThe ED Case Manager will also maintain current licensure to work in State of employment and maintain hospital credentialing as indicatedDecision-making is based on regulatory requirements, policy and procedures and current clinical guidelinesMaintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract termsRefers cases for additional support/management as deemed appropriate, following all mandated reporting laws and ethical boundsMonitors for any quality concerns regarding member care and reports as per policy and procedureUses, protects, and discloses Optum patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standardsPerforms all other related duties as assignedYou'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 Multistate RN license4+ years of diverse clinical experience in caring for acutely ill patients with multiple disease conditionsKnowledge of utilization management, quality improvement, and discharge planningKnowledgeable in Microsoft Office applications including Outlook, Word, and ExcelDemonstrated ability to read, analyze and interpret information in medical records, and health plan documentsDemonstrated ability to problem solve and identify community resourcesProven ability to execute planning, organizing, conflict resolution, negotiating and interpersonal skillsProven ability to utilize critical thinking skills, nursing judgement, and decision-making skillsProven ability to prioritize, plan, and handle multiple tasks/demands simultaneouslyAbility to provide support 24/7Preferred Qualifications:Experience working in the Emergency DepartmentExperience with managed care and/or case management experiencePhysical & Mental Requirements:Ability to sit for extended periods of timeAbility to stand for extended periods of timeAbility to use fine motor skills to operate office equipment and/or machineryAbility to receive and comprehend instructions verbally and/or in writingAbility to use logical reasoning for simple and complex problem solving*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyPay 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.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.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. xijylhu Remote working/work at home options are available for this role.

Created: 2026-04-03