Optum in the tri-state region (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group) offers an interconnected network that enables us to work collaboratively to better coordinate care among our doctors and care teams. Together, we offer you and your family access to more than 2,100 providers, representing 70 specialties, working in 360 medical practices and more than 55 urgent care locations across New York, New Jersey, and Southern Connecticut. For more information, visit www.optum.com/tri.

ProHealth is one of the largest private multi-specialty medical practices in the Northeast and has been serving the health needs of Long Island and the Greater New York Metropolitan area since 1997. With over 900 providers in 300 locations, our goal is to provide quality health care to ensure that our patients get the right care at the right time.

At Optum, we are transforming healthcare nationally while providing physician-led care locally. Work with the largest care delivery organization in the world and start doing your life's best work.(sm)

CareMount Medical, P.C. is the largest independent multispecialty medical group in New York State, providing comprehensive medical care of the highest quality to over 640,000 patients in more than 45 locations throughout Westchester, Putnam, Dutchess, Columbia, and Ulster counties and New York City. Founded in 1946 as Mount Kisco Medical Group, CareMount has grown to over 600 physicians and advanced practice professionals representing more than 40 different medical specialties. CareMount is affiliated with world-class organizations including Massachusetts General Hospital, Mount Sinai Health System, and Memorial Sloan Kettering Cancer Center. CareMount offers on-site laboratory and radiology services, endoscopy and infusion suites, and operates eight urgent-care centers. Our physicians are frequently recognized as best doctors in respected publications and have been featured in lists including New York Magazine’s “Best Doctors,” Westchester and Hudson Valley Magazine’s “Top Doctors” as well as in Castle Connolly Medical’s “Top Doctors.” For additional information about CareMount Medical and its specialties, please visit: www.caremountmedical.com.

The group has always maintained a firm commitment to each of our patients...to provide high quality medical and surgical care in a warm, friendly setting, and in a caring manner. Each and every member of our professional and support staff is dedicated to this ideal - physicians, nurses, technicians and support personnel.

Position Overview: Working with CareMount Medical’s Medical Directors, Group physicians, and Patient Care

Managers to provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The overall goal of the position is to enhance the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and management and discharge planning. Has accountability for the care, coordination and discharge planning of all patients.

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

Primary Responsibilities:

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  Orients and educates patients and their families by meeting them; explaining the role of the care management nurse; initiating the care plan; providing educational information in conjunction with direct care providers related to treatments, procedures, medications, and continuing care requirements
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  Develops interdisciplinary care plan and other care management tools by participating in meetings; coordinating information and care requirements with other care providers; resolving issues that could affect smooth care progression; fostering peer support; providing education to others regarding the case management process
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  Coordinate the integration of social services/case management functions into the patient care, discharge, and home planning processes with hospital departments, skilled nursing facilities, external service organizations (home healthcare), agencies and healthcare facilities
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  Promote effective and efficient utilization of clinical resources
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  Mobilize resources and interviews, as needed, to achieve expected goal to assist in achieving desired clinical outcomes within the desired timeframe
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  Assesses patient care required throughout continuum of care for diagnosis, procedures and DRG’s
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  Communicates with Group physicians at regular intervals throughout patient hospitalizations and develops an effective working relationship. Assist physicians to maintain appropriate cost, case, and desired patient outcomes. Complete expanded assessment of patients and family needs at time of admission. Complete psychosocial assessment. Assess patient’s progress through expected hospital course
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  Reviews daily hospital admissions/readmissions/ER reports for follow up and education &/or assistance and identifies and focuses efforts on high cost patients
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  Refers cases where patients and/or family would benefit from counseling required to complete complex discharge plan to social worker
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  Serve as a patient advocate. Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions. Facilitates interdisciplinary conferences to review treatment goals, optimize resource utilization, provide family education and identified post-hospital needs
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  Collaborate with CareMount Medical clinical staff in the development and execution of the plan of care, and achievement of goals. Directs and participates in the development and implementation of patient care policies and protocols in order to provide advice and guidance in handling special cases or patient needs
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  Coordinates the provision of social services to patients, families, and significant others to enable them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services
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  Maintains quality service by establishing and enforcing Group standards
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  Maintains patient care database by entering new information into the EMR as it becomes available; verifying findings and reports; backing up data
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  Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; benchmarking state-of-the-art practices; participating in professional societies
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  Follows up on health care measure gap reports and works with health care team to inform patients of gaps and assist in closing gap, if appropriate
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  Sets up disease registries of patients with high risk health issues, i.e., congestive heart failure, pneumonia, chronic obstructive pulmonary disease, diabetes, etc. and follows patients to ensure their health care needs are met on an ongoing basis
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  Assists with creating physician profile/comparison reports on various health measures and utilization such as immunization rates, advanced imaging utilization, etc. Presents and explains reports as needed
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  Contributes to team effort by accomplishing related results as needed

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:

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  Associate degree in healthcare related field
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  Bachelor’s or Master’s degree in related healthcare field (such as social work) may be considered
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  Maintain current professional licensure in nursing or professional field of certification
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  2+ years of utilization review/case management experience
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  Working knowledge of Microsoft Office including Outlook and Excel
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  Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

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  Bachelor’s degree in nursing
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  Appropriate certification in case management (e.g., Commission for Case management Certification (CCMC); Association of Rehabilitation Nurses (ARN)
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  1+ years of experience in discharge planning from a hospital

Typical Physical Demand: Requires full range of body motion including moving and lifting patients, manual and finger dexterity and eye-hand coordination. Requires sitting and/or standing for extended periods of time. Occasionally exerts up to 100 pounds of force, such as assisting patients in arising from the exam table, pushing patients in wheelchairs, or assisting patients into/out of wheelchairs. Requires corrected vision and hearing to normal range

Typical Working Conditions: May require frequent exposure to communicable diseases and body fluids, toxic substances, medicinal preparations, and other substances and conditions common to a medical office/healthcare environment. Requires use of telephone and computer, potentially for long periods of time. Requires driving to hospitals, patient homes, and CareMount Medical offices other than their primary CareMount Medical office location. Subject to irregular or flexible hours to meet deadlines.

CareMount Medical, ProHEALTH Care Associates, and Riverside Medical Group (the “Practices”) are all physician owned and led practices having complete authority for all medical decision-making and patient care through their physicians and other licensed professionals. Optum, through its management organizations (“Optum”) provides non-clinical administrative services to support the Practices and their physicians. Neither Optum nor its management companies employ, engages, or supervises physicians or other licensed professionals, or determines or sets the methods, standards, or conduct of the practice of medicine or health care provided by the Practices or by any of their licensed professionals. “Part of Optum” reflects that the Practices are part of Optum’s effort to support forward-thinking physician practices in helping their patients live healthier lives.

All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status.

CareMount is an EO employer - M/F/Veteran/Disability

Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $27.07 to $53.08. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.