Complex Case Manager, RN - Hybrid

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.

Telecommuting is defined as a work arrangement in which the employee works outside the office, typically working from home, every day and may occasionally come into one of our facilities or client/customer sites for meetings, training, or events.

Primary Responsibilities:

• Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member's health, social determinants, and gaps in care
• Creates and implements a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient's needs and goals
• Performs ongoing updates of the care plan to evaluate effectiveness, and to document barriers, interventions, and goal achievement
• Partners with primary providers or multidisciplinary team members to align or integrate goals to plan of care
• Completes telephonic visits for member engagement and enrollment
• Uses motivational interviewing to evaluate, educate, support, and motivate change during member contacts
• Identifies and considers appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
• Ensures compliance with quality metrics specific to health plan delegation and accrediting body requirements
• Conducts self and peer audits on a regular and assigned timeline
• Maintains caseload per defined medical management department standards
• Sustains productivity and audit requirements per medical management department standards
• Demonstrates ability to work independently and implement innovative approaches to complex member situations
• Determines need for continued member management, creates care plan and facilitates transition to medical management programs
• Attends departmental meetings and provides constructive recommendations for process improvement
• Performs 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:

• Graduation from an accredited school of nursing
• Active, unrestricted Registered Nurse license through the State of California
• 1+ years of care management, utilization review or discharge planning experience in clinical setting
• Microsoft Tools

Preferred Qualifications:

• Bachelor of Science in Nursing, BSN
• 3+ years of experience working in acute care
• HMO 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 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.

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

Client-provided location(s): San Diego, CA

Job ID: UHG-1043823

Employment Type: FULL_TIME

Posted: 2025-08-08T04:49:51