RN Telephonic Case Manager
UnitedHealth Group - Richardson, TX

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***This position requires a flexible working schedule, as there could be some evening/weekend work - additional compensation will be provided for working into the evenings and on weekends. There is also an option to work from home after 6 months of employment as long as metrics are being met.***

Looking to grow your career within a large, progressive organization? Join OptumHealth as an RN Nurse Case Manager!

In this role, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring and evaluating. This may include case management, disease management, coordination of care and medical management consulting. You will also be responsible for providing health education, coaching and treatment decision support for members. Case Managers work in a variety of settings: in the community providing proactive care coordination to individuals and support to their families or in telephonic care management position.

Want to learn more before applying for this role? Click here to view the Realistic Job Preview: Telephonic_Case_Manager_Optum.pdf

Primary responsibilities:
  • Making outbound calls to assess members' current health status
  • Identifying gaps or barriers in treatment plans
  • Providing patient education to assist with self management
  • Interacting with Medical Directors on challenging cases
  • Coordinating care for members
  • Making referrals to outside sources
  • Coordinating services as needed (home health, DME, etc)
  • Educating members on disease processes
  • Encouraging members to make healthy lifestyle changes
  • Documenting and tracking findings
  • Utilizing Milliman criteria to determine if patients are in the correct hospital setting
  • Making "welcome home" calls to ensure that discharged member receive the necessary services and resources

Basic Qualifications:

-Minimum 3 years of professional RN level clinical experience

-Current, unrestricted RN license in TX

-Advanced computer proficiency (MS Word, Outlook, Internet)

-CCM, or obtainment of CCM within 36 months of employment

Preferred Qualifications:

-Previous managed care experience

-Prior experience working with Government programs

-Case management background

-Experience working with Milliman

-Utilization review experience


OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling. By providing 58 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.

At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business, and make contributions that will have an impact that's greater than you've ever imagined.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: RN, nurse, case manager, case management, CCM, Richardson, TX

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