Nurse Case Manager - Essex County NJ

$40 - $54 / hour

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together

We're making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that's driving the health care industry forward. As a Case Manager RN, you'll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come.

If you are located within Essex County, New Jersey, territory and willing to travel up to 80% of your time to assigned territory, you will have the flexibility to work remotely as you take on some tough challenges

Primary Responsibilities

Comprehensive Assessment & Care Planning

Conduct thorough health assessments, including medical history, chronic conditions, behavioral health, and social determinants of health
Develop individualized care plans that address medical, rehabilitation, behavioral health, and social needs
Create personalized interventions that integrate medical treatment, support services, and community resources

Member Engagement, Education & Self-Management

Build and maintain relationships with an established caseload of high-risk members
Provide education to members and caregivers on disease processes, treatment adherence, and lifestyle changes
Encourage self-management strategies that support long-term wellness and reduce complications
Maintain consistent outreach to support adherence to care plans and monitor evolving needs

Intensive Care Coordination

Coordinate services across providers, including PCPs, specialists, hospitals, LTSS, behavioral health, and pharmacy.
Facilitate referrals for home health, hospice, palliative care, and DME
Collaborate with Medical Directors during interdisciplinary rounds to review and align care for complex cases

Discharge Planning & Transitional Care

Support members through transitions of care such as hospitalization, skilled nursing, and rehabilitation
Conduct "welcome home" and follow-up calls to ensure post-discharge services, medications, and follow-up appointments are in place
Deliver intensive outreach during the 30-day post-discharge period to reduce avoidable readmissions and ED utilization
Advocate for safe, coordinated, and timely transitions of care that align with the member's individualized care plan

Field-Based Care Management (20% of Time)

Conduct home and hospital visits in North Jersey as required by program guidelines
Perform in-person assessments and provide care coordination to address high-risk needs and ensure continuity of care
Collaborate directly with providers, facilities, and families during field visits to close care gaps and reinforce the care plan

Monitoring & Clinical Oversight

Monitor members' clinical conditions, care plan progress, and treatment adherence
Reassess care plans regularly and adjust interventions based on changing needs or barriers
Identify red-flag conditions and escalate urgent or complex cases for higher-level review and intervention
Documentation, Compliance & Quality Outcomes

Document all assessments, care plans, interventions, and communications per NCQA, CMS, and state regulatory requirements

Ensure care management services align with DSNP/NCQA standards and contract requirements
Track outcomes tied to quality metrics (HEDIS, STARs), utilization management, and member satisfaction
Maintain audit readiness through timely, accurate, and comprehensive documentation

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 New Jersey
2+ years of Case Management Experience serving complex, elderly and disabled
Experience with government health programs (Medicaid/Medicare)
Proficient in Microsoft Office Suite; tech-savvy with ability to navigate multiple systems simultaneously
Demonstrated ability to talk and type proficiently at the same time
Access to reliable transportation and the ability to travel up to 80% within assigned territory.
Available for occasional in-person meetings as needed

Preferred Qualifications

Certified Case Manager (CCM)
Experience working with populations with special needs (DSNP)
Experience with Managed Care Population
Bilingual - English/Spanish

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 $40.00 to $54.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group 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.

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

Share this job

Related Jobs

Infusion

Full-time

Nurse Case Manager- Home Infusion

Pharmko Lawrence, NY

Nurse Case Manager . Home Infusion Pharmko . New York, NY Full-time . In-person . Travel required About Us Pharmko is a specialty home infusion pharmacy focused on delivering safe, high-quality and reliable patient care. We manage complex infusion therapies including TPN, specialty injectables and ongoing clinical support for patients transitioning from hospital to home. We are seeking an experienced Nurse Case Manager to join our clinical team. This role is fully in person and requires travel to hospitals and patient homes for bedside teaching and infusion education. Responsibilities Coordinate and track laboratory work for infusion patients. Evaluate central and peripheral line infections, monitor catheter placement status and collaborate with physicians on clinical interventions. Provide bedside teaching in hospitals and patient homes. Educate patients and caregivers on medication administration, line care, infusion protocols and safety procedures. Serve as the central liaison among physicians, hospital discharge teams, caregivers and the home infusion pharmacy. Ensure smooth transitions from hospital to home infusion. Maintain precise and compliant documentation within EMR systems. Manage a structured patient caseload with strict attention to detail, follow-ups and scheduling. Uphold clinical standards, infection prevention practices and regulatory compliance. Qualifications Required: Active Registered Nurse (RN) license in New York State. Minimum 3 years of clinical experience in home infusion, acute care or infusion pharmacy. Strong organizational skills and rigorous attention to detail. Excellent communication skills with patients, caregivers and medical teams. Experience with central line management and infusion therapy. Ability to travel to hospitals and patient homes as needed. Preferred: Experience with TPN or other complex infusion therapies. Additional out-of-state RN licenses. Case management or infusion-specific certifications. Experience with hospital-to-home transitions. Compensation Base salary: $80,000 . $95,000/year , depending on experience. Full benefits package including health coverage, PTO, CE/licensure support and travel reimbursement. Opportunities for growth within Pharmko’s clinical leadership structure. Schedule Full-time In person Travel to hospitals and patient homes as required

Full-time

Remote Care Manager- RN/ Colorado

Pharmko Lawrence, NY

CCM/RPM The ideal candidate works in collaboration and continuous partnership with chronically ill patients and their family/caregiver(s), clinic/hospital/specialty provider and staff, and community resources in a team We are seeking a bilingual and remote care manager to join our rapidly growing team at Preventel Health performing Chronic Care Management (CCM), Remote Patient Monitoring (RPM) and Behavioral Health Integration (BHI) by telephonically delivering health and wellness calls to assigned patients. Responsibilities: Remotely providing basic patient coaching and care to improve patient outcomes Develop a care plan with the patient, family/caregiver(s) and provider Monitor patient outcomes, adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner and facilitate changes as needed Coaching and educating patients on improving their Chronic Conditions, preventive care and physician directives Telephone outreach to English and Spanish-speaking patients Facilitate CCM, RPM and BHI program enrollment Concise and accurate documentation Cultivate and support the primary care providers with timely communication, inquiry follow-up, and integration of information into the care plan regarding transitions-in-care and referral Requirements: Must be mininally licensed RN COLORADO Must have good customer service skills Prefer Bilingual (Spanish) Knowledgeable with Microsoft Office Reliable Computer with internet COMPENSATION: Based on a base plus incentive model.

Full-time

RN: Remote Care manager, Puerto Rico

Pharmko Lawrence, NY

CCM/RPM The ideal candidate works in collaboration and continuous partnership with chronically ill patients and their family/caregiver(s), clinic/hospital/specialty provider and staff, and community resources in a team We are seeking a bilingual and remote care manager to join our rapidly growing team at Preventel Health performing Chronic Care Management (CCM), Remote Patient Monitoring (RPM) and Behavioral Health Integration (BHI) by telephonically delivering health and wellness calls to assigned patients. Responsibilities: Remotely providing basic patient coaching and care to improve patient outcomes Develop a care plan with the patient, family/caregiver(s) and provider Monitor patient outcomes, adherence to care plans, evaluate effectiveness, monitor patient progress in a timely manner and facilitate changes as needed Coaching and educating patients on improving their Chronic Conditions, preventive care and physician directives Telephone outreach to English and Spanish-speaking patients Facilitate CCM, RPM and BHI program enrollment Concise and accurate documentation Cultivate and support the primary care providers with timely communication, inquiry follow-up, and integration of information into the care plan regarding transitions-in-care and referral Requirements: Licensed Nurse required Must be mininally licensed RN in FL,CO or NY Must have good customer service skills Prefer Bilingual (Spanish) Knowledgeable with Microsoft Office Reliable Computer with internet COMPENSATION: Based on a base plus incentive model.

Full-time

Clinical Eligibility Nurse (RN)

Integra Vascular Woodmere, NY

Clinical Eligibility Nurse Location: Woodmere, NY Reports To: Director of Clinical Operations Supervises: SVI Scheduling Coordinator Schedule: Full-Time, Monday–Friday About Integra Vascular Integra Vascular provides patient-focused, preventative vascular care to residents of our communities and long-term care facilities. Our mission is to minimize unnecessary wounds, hospitalizations, and travel through early diagnosis and exceptional onsite treatment. Guided by our commitment to clinical excellence, we deliver cutting-edge vascular care that improves function, comfort, and quality of life for every patient we serve. Position Overview The Clinical Eligibility Nurse plays a key role in ensuring the safe and appropriate scheduling of patients for mild interventional SVI (Superficial Venous Insufficiency) treatments such as Varithena, Venaseal, and radiofrequency ablation. Working from Integra Vascular’s Woodmere office, this position requires a clinically skilled Registered Nurse who can review patient records, determine eligibility for treatment, and coordinate the scheduling workflow in partnership with the Brooklyn OBL team. The Clinical Eligibility Nurse serves as the bridge between clinical review and operational execution, overseeing the SVI Scheduling Coordinator to ensure that all approved patients are efficiently scheduled for procedures in compliance with clinical and administrative standards. Key Responsibilities · Review patient records, diagnostic imaging, and referring physician notes to assess eligibility for SVI treatments. · Verify that all necessary clinical documentation and diagnostics are complete prior to scheduling. · Communicate directly with referring providers, facility contacts, and internal teams to clarify clinical findings or missing documentation. · Maintain and update the master SVI patient list, ensuring accurate tracking from review to procedure. · Oversee the SVI Scheduling Coordinator and provide clinical guidance regarding patient prioritization and scheduling order. · Collaborate with the Director of Clinical Operations to forecast procedural volume and optimize scheduling efficiency for SVI days at the Brooklyn OBL. · Ensure all scheduled cases meet medical necessity and internal compliance criteria. · Support adherence to state and federal healthcare regulations, as well as Integra Vascular’s internal standards. · Monitor and report on eligibility trends, procedural approval rates, and scheduling metrics to identify opportunities for process improvement. · Serve as the primary point of contact between the clinical review process and scheduling operations. · Work closely with the clinical and administrative teams to ensure a seamless patient experience from referral to treatment. · Participate in team meetings and provide feedback on workflow enhancements. Qualifications · Active Registered Nurse (RN) license in the State of New York (required). · Minimum 2 years of clinical experience in vascular, interventional radiology, or related specialty preferred. · Strong knowledge of venous disease, SVI treatments, and related clinical criteria. · Excellent organizational and communication skills with the ability to manage multiple priorities. · Proficient in EMR systems and patient tracking platforms. · Demonstrated leadership ability with experience overseeing administrative or clinical support staff a plus. Benefits · Comprehensive Health Insurance (Medical, Dental, Vision) · Flexible Spending Account (FSA) and Dependent Care Account (DCA) options · 401(k) Retirement Plan with company match · Paid Time Off (PTO) and company-recognized holidays · Professional development and continuing education support · Collaborative and growth-oriented clinical environment #INDNCL

Med-Surg

Full-time

Registered Nurse (Med Surg)

Northwell Health Manhasset, NY

$60 - $90 / hour

177602 Job Description Performs an age specific plan of care for a designated group of patients using the nursing process of assessment, diagnosis, outcome identification, planning, implementation, and evaluation of patient care. Collaborates with physicians and other health team members in coordinating and implementing procedures and treatments. Uses leadership skills/clinical judgment in coordinating patient care and directing/delegating activities of the patient care unit team. Job Responsibility Conducts patient interview, explains policies and procedures to patient/ significant others, reviews patient’s chart and answers questions correctly and courteously; assesses gastrointestinal, cardiovascular, respiratory, renal and neurological health status; determines mobility, sensory deficits, prostheses use, and skin condition and adjusts plan of care, as appropriate; assesses level of pain and pain management; communicates/documents patient’s physiologic health status and plan of care; assesses patient’s psychosocial health status; elicits perception of medical/nursing care and the expectation of care. Determines coping mechanism, knowledge level, and ability to comprehend; identifies cultural/ethnic requirements to reduce anxiety and ensure patient satisfaction; communicates and documents psychological status and care plan of support groups, counseling services, and social services; identifies patient outcome; develops criteria for measurement of patient outcomes; identifies actual/potential patient problems; identifies patient’s need for teaching based on psychosocial and developmental assessment. Develops patient outcome statement (s) and establishes individualized patient goals; identifies care activities and establishes the priorities necessary to achieve expected outcome; coordinates the cost-effective use of supplies, equipment and medication to achieve expected outcome; documents the plan of care and collaborates with physicians and other health team members; implements the plan of care; maintains constant vigilance over patients care to ensure that safety precautions/needs are followed (side rails up, call lights and bedside stand within reach, etc.). Exercises professional skills related to the plan of care; reassesses patients as needed and appropriately revises plan of care; correctly administers prescribed treatments; correctly uses equipment necessary for patient care; provides emotional support to patient and significant other; applies scientific principles in performing procedures; carries them out safely, timely and efficiently; makes accurate observations of patient’s conditions during treatments/procedures; reports and records same as appropriate; Keeps accurate documentation of patient’s treatment, activity and condition, as well as patient’s responses to medical and nursing interventions; uses appropriate methods of documentation according to departmental policy; acts rapidly and effectively during any emergency situation, managing self, patients and other employees; provides a calm, quiet, restful atmosphere; communicates effectively with the patient’s family or caretakers; participates in planning for discharge and coordinates referrals, as appropriate; provides discharge instructions to patient and significant other; evaluates care provided for patient outcome. Demonstrates ability to measure effectiveness of care provided and documents same; performs variance analysis related to outcome data for performance improvement; designs, implements, and evaluates systems to improve care in unit; keeps accurate documentation of patient’s treatment, activity and condition; uses appropriate methods of documentation according to departmental policy; collaborates with other care team members in planning and carrying out treatment regimen; provides direction to other members of the care team; collaborates with the appropriate physician on patient’s plan of care. Accurately interprets and implements treatment regimen as prescribed by the Physician; assists the Physician during treatments and/or diagnostic procedures; keeps the Patient Care Manager/designee and/or physician, abreast of changes in patient’s condition and/or treatments, as appropriate; uses clinical judgment in delegating assignments in providing patient care, and ensures that assignments are completed in a timely fashion; performs grade I-IV Decubitus Care; performs preventive skin care measures; applies simple dressings, maintaining principles of aseptic technique. Applies warm and cold compresses, consistent with facility procedure; performs irrigations, consistent with Facility procedure; performs other procedures related to skin care, as necessary; administers medications correctly and safely; correctly identifies medication in terms of action, dosage, side effects, and implications for the patient; meets standard on medication administration examination; demonstrates preparation of local solutions. Administers and documents medication correctly; educates patients and significant others related to drug and food interactions; educates patients and significant others related to drug and food interactions; participates in patient and family education; provides patient with an explanation of his/her condition as indicated; communicates assessment data in an orderly fashion by recording, updating and verbalizing pertinent information to care team members and to appropriate agencies; recognizes and utilizes health teaching opportunities and resources /materials available for this teaching; provides for early discharge planning and appropriate referrals for post-hospital care; evaluates the effectiveness of teaching by feedback from patient/ family and documents same. Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions. Job Qualification Graduate from an accredited School of Nursing. Bachelor’s Degree in Nursing, preferred. Must be enrolled in an accredited BSN program within two (2) years and obtain a BSN Degree within five (5) years of job entry date. Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed. Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future.When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).