UnitedHealth Group

Case Manager Nurse - Optum Frontier Therapies

UnitedHealth Group$60K — $107K *
Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Unencumbered Registered Nurse in the state of residence
  • Nurse Licensure Compact (NLC) holder
  • Verification or certificate from an approved school of Nursing
  • 5+ years of experience in a patient-facing role

Responsibilities

  • Conduct comprehensive patient assessments via phone and document in proprietary platform
  • Engage with patients and caregivers to understand health needs and develop care plans
  • Manage inbound and outbound patient calls while maintaining service quality
  • Build relationships with clinical pharmacists to support patient care
  • Communicate with providers and staff regarding patient needs
  • Document adverse events and engage with clients as needed
  • Ensure compliance with licensing standards and regulations, including HIPAA and pharmacy standards

Benefits

  • Comprehensive benefits package
  • Incentive and recognition programs
  • Equity stock purchase program
  • 401k contribution options
  • Development opportunities for career advancement
Full Job Description
The Case Manager Nurse in Optum Frontier Therapies will directly support our clinical model serving patients with rare diseases by developing relationships with patients while conducting assessments specific to their therapy. This role will be under direct supervision from the Clinical Operations Supervisor.

Candidate must be willing to work 8:30am-5:00pm Pacific time.

Primary Responsibilities:

  • Conduct comprehensive patient level assessments over the phone with documentation in proprietary platform
  • Conduct meaningful conversations with patients and their caregivers to understand the need for interventions to enhance their overall health outcomes and develop care plans
  • Manage inbound and outbound calls from patients and caregivers while maintaining quality services levels
  • Develop relationship with clinical pharmacist staff as partners in the overall care continuum of the patient
  • Communicate with providers office and their staff as appropriate for patient needs
  • Conduct adverse event, product complaint, and special situation conversations with patient. Document and engage with clients as appropriate per program requirement.
  • Adheres to all operations, practices and procedures to meet all licensing and standards requirements established by local, state and federal agencies as well as accrediting bodies (e.g. ACHC, URAC)
  • Ensures compliance with all controlled substances related rules, regulations, company policies and maintains proper communication and coordination with other departments and staff
  • Compliance to and education for all accreditation programs including ACHC, URAC, etc.
  • Compliance to all REMS program requirements, as applicable.
  • Monitors for compliance with all HIPAA regulations, adherence to all State and Federal regulations and laws, accrediting bodies, adherence to all pharmacy accepted standards of practice
  • Willingness to support clinical functions including prior authorization and appeal reviews, override requests, and inbound and outbound patient and provider education calls.
  • Provides insight to platform improvement(s) and process improvement(s)
  • Willingness to obtain all licenses as required to service patients living in any state or territory
  • Completes special duties or projects as assigned by leadership


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:

  • An unencumbered Registered Nurse in the state of residence
  • Nurse Licensure Compact (NLC)
  • Verification or certificate from an approved school of Nursing
  • 5+ years of experience in patient facing field (Required)


Preferred Qualifications:

  • Multistate licensure in state(s) not participating in Nurse Licensure Compact
  • Experience in the rare disease space
  • Experience with telephony-based care services
  • Baseline proficiency in the entire prior authorization and appeals process for specialty prescription medications, infusions, medical procedures and devices to provide cross functional support as deemed appropriate
  • Possess solid verbal and written communication skills, interpersonal relationship skills
  • Exceptional organizational, time management skills working toward hard deadlines to meet key performance metrics
  • Excellent troubleshooting, problem solving and interpersonal skills effective with multiple levels / professional disciplines as well as patients, families, staff and physicians
  • Be a team player and collaborate across functions


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 $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ

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