Hybrid RN Case Manager Orlando FL
Company: Optum
Location: Orlando
Posted on: July 8, 2025
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Job Description:
WellMed, part of the Optum family of businesses, is seeking a RN
Case Manager to join our team in Orlando, FL. Optum is a
clinician-led care organization that is changing the way clinicians
work and live. As a member of the Optum Care Delivery team, you’ll
be an integral part of our vision to make healthcare better for
everyone. At Optum, you’ll have the clinical resources, data and
support of a global organization behind you so you can help your
patients live healthier lives. Here, you’ll work alongside talented
peers in a collaborative environment that is guided by diversity
and inclusion while driving towards the Quadruple Aim. We believe
you deserve an exceptional career, and will empower you to live
your best life at work and at home. Experience the fulfillment of
advancing the health of your community with the excitement of
contributing new practice ideas and initiatives that could help
improve care for millions of patients across the country. Because
together, we have the power to make health care better for
everyone. Join us and discover how rewarding medicine can be while
Caring. Connecting. Growing together. This is a hybrid position
that requires 2 days remote and 3 days a week in travel within the
Orlando area. Hours: Monday-Friday: 8am-5pm This position follows a
hybrid schedule with three in-office days per week. Primary
Responsibilities: - Collaborates effectively with integrated care
team (ICT) to establish an individualized plan of care for members.
The interdisciplinary care team develops interventions to assist
the member in meeting short and long term plan of care goals -
Serves as the clinical liaison with hospital, clinical and
administrative staff as well as provides expertise for clinical
authorizations for inpatient care. based on utilized
evidenced-based criteria - Performs concurrent and retrospective
onsite or telephonic clinical reviews at the designated network or
out of network facilities. Documents medical necessity and
appropriate level of care utilizing national recognized clinical
guidelines - Stratifies and/or validates patient level of risk and
communicates during transition process with the Integrated Care
Team - Provide assessments of physical, psycho-social and
transition needs in settings not limited to the PCP office,
hospital, or member’s home. Develops interventions and processes to
assist the member in meeting short and long term plan of care goals
- Manages assigned case load in an efficient and effective manner
utilizing time management skills to facilitate the total work
process directly monitoring assigned members - Demonstrates
knowledge of utilization management and care coordination processes
and current standards of care as a foundation for transition
planning activities - Confers with physician advisors on a regular
basis regarding inpatient cases and participates in department case
rounds. Plans member transitions, with providers, patient and
family. - With the assistance of the Managed Care/UM teams, guides
physicians in their awareness of preferred contracts and providers
and facilities - Refers cases to Medical Director as appropriate
for review or requests not meeting criteria or for complex case
situations - Participates in the development of appropriate QI
processes, establishing and monitoring indicators In 2011, WellMed
partnered with Optum to provide care to patients across Texas and
Florida. WellMed is a network of doctors, specialists and other
medical professionals that specialize in providing care for more
than 1 million older adults with over 16,000 doctors’ offices. At
WellMed our focus is simple. We’re innovators in preventative
health care, striving to change the face of health care for
seniors. WellMed has more than 22,000 primary care physicians,
hospitalists, specialists, and advanced practice clinicians who
excel in caring for 900,000 older adults. Together, we're making
health care work better for everyone. 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 in Nursing, or Associate’s degree in Nursing and Bachelor’s
degree in related field, or Associate’s degree in Nursing combined
with 4 of years of experience - Current, unrestricted RN license
required, specific to the state of employment - Case Management
Certification (CCM) or ability to obtain CCM within 6months after
the first year of employment - 5 years of diverse clinical
experience in caring for the acutely ill patients with multiple
disease conditions - Proven knowledge of utilization management,
quality improvement, discharge planning, and cost management -
Proficient with Microsoft Office applications including Word,
Excel, and Power Point - This position requires Tuberculosis
screening as well as proof of immunity to Measles, Mumps, Rubella,
Varicella, Tetanus, Diphtheria, and Pertussis through lab
confirmation of immunity, documented evidence of vaccination, or a
doctor's diagnosis of disease Preferred Qualifications: - 2 years
of managed care and/or case management experience - Experience
working with geriatric patient population - Bilingual (English /
Spanish) language proficiency 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 $58,800 to $105,000 annually
based on full-time employment. We comply with all minimum wage laws
as applicable. 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.
Keywords: Optum, Fort Pierce , Hybrid RN Case Manager Orlando FL, Healthcare , Orlando, Florida