Optum is hiring: Case Manager Nurse - NCLEX - San Juan, PR in San Juan

Case Manager Nurse - NCLEX

Location: San Juan, PR

Company: Optum

The Case Manager Nurse - NCLEX will work within our global organization to improve health outcomes by connecting patients with necessary care and resources. The role is full-time (40 hrs/week) with flexible 8‑hour shifts during 9:00 am–6:00 pm AST, and may require occasional overtime or weekend work. The position may involve a telecommute component and requires an active Registered Nurse compact license.

Primary Responsibilities

• Assist with coordinating and supervising daily activities of LPNs, RNs, and support teams
• Support digital and telephonic triage during high‑volume periods
• Manage nursing human resource objectives: orientation, training, scheduling, coaching, counseling, and disciplinary actions; communicate job expectations; monitor performance; recommend compensation actions; adhere to policies and procedures
• Meet nursing operational standards by contributing to strategic plans, implementing productivity and quality standards, resolving problems, and identifying system improvements
• Establish personal rapport with patients and others to identify service requirements
• Ensure quality of care by developing and interpreting operational and nursing division philosophies, enforcing state board of nursing and other regulatory requirements, measuring health outcomes, and recommending adjustments
• Utilize multidisciplinary team strategies to resolve patient needs
• Maintain confidential information and protect operations
• Stay current with professional knowledge by participating in workshops, publications, and societies
• Accept ownership of new requests and explore opportunities to add value

Required Qualifications

• NCLEX certification
• Current unrestricted RN licensure in applicable state
• 3+ years of health‑care experience, including managed care setting
• Case management experience
• Proficiency with Microsoft Office, including databases, word processing, and Excel
• Professional proficiency in English and Spanish (English proficiency assessment required)

Preferred Qualifications

• Bachelor’s degree or higher
• Current unrestricted RN license in Puerto Rico
• Experience with HEDIS/Star programs
• Experience in provider interactions and education
• Experience with data analysis and quality chart reviews
• Experience influencing provider behavior to improve quality
• Experience in managed‑care network and provider relations
• Experience interacting with medical staff and internal staff at all levels
• Process‑improvement experience across functional areas
• Billing and CPT coding experience
• Call center experience
• Clinical data abstraction experience
• Solid knowledge of Medicare market and products
• Problem‑solving skills and strong communication and customer service skills

Additional Information

English proficiency assessment will be required after application. Candidates must be able to obtain additional non‑compact state licenses upon request.

Equal Employment Opportunity

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.

We are committed to building a diverse workforce and believe everyone deserves the opportunity to live their healthiest life.