Telephonic Nurse Case Manager - Remote - Remote Eligible

Caring. Connecting. Growing Together.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable.

We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Telephone Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today.

If you are located within Northern New Jersey territory and willing to travel up to 20% of your time to assigned territory, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

Comprehensive Assessment & Care Planning:

• Conduct thorough health assessments, including medical history, chronic conditions, behavioral health, and social determinants of health
• Develop individualized care plans that address medical, rehabilitation, behavioral health, and social needs
• Create personalized interventions that integrate medical treatment, support services, and community resources

Member Engagement, Education & Self-Management:

• Build and maintain relationships with an established caseload of high-risk members
• Provide education to members and caregivers on disease processes, treatment adherence, and lifestyle changes
• Encourage self-management strategies that support long-term wellness and reduce complications
• Maintain consistent outreach to support adherence to care plans and monitor evolving needs

Intensive Care Coordination:

• Coordinate services across providers, including PCPs, specialists, hospitals, LTSS, behavioral health, and pharmacy.
• Facilitate referrals for home health, hospice, palliative care, and DME
• Collaborate with Medical Directors during interdisciplinary rounds to review and align care for complex cases

Discharge Planning & Transitional Care:

• Support members through transitions of care such as hospitalization, skilled nursing, and rehabilitation
• Conduct "welcome home" and follow-up calls to ensure post-discharge services, medications, and follow-up appointments are in place
• Deliver intensive outreach during the 30-day post-discharge period to reduce avoidable readmissions and ED utilization
• Advocate for safe, coordinated, and timely transitions of care that align with the member's individualized care plan

Field-Based Care Management (20% of Time):

• Conduct home and hospital visits in North Jersey as required by program guidelines
• Perform in-person assessments and provide care coordination to address high-risk needs and ensure continuity of care
• Collaborate directly with providers, facilities, and families during field visits to close care gaps and reinforce the care plan

Monitoring & Clinical Oversight:

• Monitor members' clinical conditions, care plan progress, and treatment adherence
• Reassess care plans regularly and adjust interventions based on changing needs or barriers
• Identify red-flag conditions and escalate urgent or complex cases for higher-level review and intervention

Documentation, Compliance & Quality Outcomes:

• Document all assessments, care plans, interventions, and communications per NCQA, CMS, and state regulatory requirements
• Ensure care management services align with DSNP/NCQA standards and contract requirements
• Track outcomes tied to quality metrics (HEDIS, STARs), utilization management, and member satisfaction
• Maintain audit readiness through timely, accurate, and comprehensive documentation

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's degree or greater
• Current, unrestricted RN license in New Jersey
• 2+ years of Case Management Experience serving complex, elderly and disabled
• Experience with government health programs (Medicaid/Medicare)
• Proficient in Microsoft Office Suite; tech-savvy with ability to navigate multiple systems simultaneously
• Demonstrated ability to talk and type proficiently at the same time
• Access to reliable transportation and the ability to travel up to 20% within assigned territory.
• Available for occasional in-person meetings as needed

Preferred Qualifications:

• Certified Case Manager (CCM)
• Experience working with populations with special needs (DSNP)
• Experience with Managed Care Population
• Bilingual - English/Spanish

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 $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.