RN Senior Case Manager Telephonic

RN Sr Case Manager Full Time Telephonic On Call Pennsylvania

Location: United States

Division:Complex Care Mgmt
Contest Number: 868295
Family: Nursing
Function: Case Management
BusinessSegment: ECS – Care Services
Region: North America
Country: United States
Employee Status: Regular
Schedule: Full-time
JobLevel: Individual Contributor
Travel: No
Overtime Status: Exempt
TelecommuterPosition: Yes

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 and help people live healthier lives while doing your life’s best work.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Work from home a combination of:

  • Weekdays: 5 pm – 8 am
  • 8 am – 8 pm & 8 pm – 8 am weekend & holidays (Saturdays and Sundays) – OVER NIGHT (must be awake)
  • PLUS rotating holidays
  • Every other weekend,12 hr shifts required

An RN functions as part of the On-Call team, and reports to the On-Call Clinical Services Manager. The RN performs activities that fall within the RN scope of practice. This role works in close collaboration with all of the team members, and may support multiple providers. The RN works under the direction of the provider and activities are delegated to the RN by the provider or the team Clinical Services Manager. The RN understands and supports the CCM models of care including the Institutional Special Needs Plan (ISNP), Institutional Equivalent Special Needs Plan (IESNP), Dual-Eligible Special Needs Plan (DSNP), and Transitions to Skilled (TTS).

Primary Responsibilities:

Care Coordination

  •  Assist the provider/team with various care coordination activities to support the role of the On-Call APCs
  •  Responsible for collaborating with the nursing facility and community members to identify and respond to changes in condition
  •  Assist the provider/team with inbound and outbound communications for members including telephonic assessments, acuity follow-ups, and high-risk facility outreach

Team Support

  •  Assist in the coordination of tracking transfers (HUB specific)
  •  Participate in the onboarding of new clinical staff under the direction of the CSM – the RN may coordinate onboarding activities, and participate in other orientation activities under the direction of the CSMs or DCOs


  •  Document all clinical information, telephonic assessments, and activities in the appropriate documentation tool

RN to APC Hand Off

  •  One entry by the RN and one responding entry by the APC should be recorded in the appropriate documentation tool
  •  RN is responsible for escalating appropriate calls to the On-Call APC

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:

  • Current, unrestricted RN license in Pennsylvania
  • 3+ years direct care clinical experience in a hospital, acute care, home health/hospice
  • Dedicated space for home office set up
  • Access to high speed internet services
  • Proficient with Microsoft Word, EMR and ability to navigate a Windows environment

Preferred Qualifications:

  • Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
  • Experience triaging calls


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UnitedHealth Group

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