Living Room Conversation Specialist

Provides telephonic care management for members through outbound calls, care coordination, individualized care plans, health education, medication reviews, referrals, and patient advocacy. The RN Case Manager collaborates with interdisciplinary teams, identifies treatment barriers, maintains HIPAA compliance, and works efficiently in a high-volume remote environment. The role requires an unrestricted compact RN license, potential multistate licensure, strong computer skills, and at least three years of registered nursing experience.

Leads Optum Behavioral Health’s payer affordability and value creation portfolio. Develops strategic priorities, business cases, roadmaps, governance, and measurable initiatives across clinical, network, payment integrity, finance, analytics, product, and operations. Identifies cost and quality improvement opportunities, guides execution from concept through implementation, validates financial impact, and communicates progress and recommendations to executives and stakeholders. Promotes analytics, digital tools, automation, and AI-enabled improvements while ensuring accountability, regulatory alignment, customer value, access, and member experience.

Serves as a liaison between a health plan and provider community, resolving issues involving claims, reimbursement, eligibility, prior authorization, credentialing, and enrollment. Builds provider relationships, collaborates with claims and network teams, supports provider network operations, and recommends process improvements. The role requires payer or managed care experience and is remote for candidates in the Philadelphia Metro Area.