u/CocoBelle74

Hi everyone! I recently received an offer for an RN Complex Case Manager position with Optum/UHC, and I’m hoping to hear from current or former RN case managers about what the day-to-day workload is actually like.
I’ve been an RN for many years and have extensive managed-care experience, including both UM and case management. I’m currently with Anthem/Elevance on a national commercial case management team, and the workload/metrics have become pretty intense.
Right now, I’m used to:
Around 30 new engagements per month
Maintaining roughly 60–70 active cases
Provider outreach and member calls
Team lead/medical director rounds
Pod meetings/calls
Documentation and care plans
Quality/audit requirements of around 90%+
Constant productivity and engagement metrics
The Optum position would be Complex Case Management, primarily Medicare. I was told the caseload is approximately 40–45 members, and cases may be followed for several months.
For anyone currently doing this role (or who has done it recently), what are the actual metrics like?
How many calls/outreaches are expected per day? How many new cases are you expected to pick up? Are there strict engagement/closure requirements? How heavily are calls and productivity monitored? And most importantly — is a 40–45 member caseload realistically manageable during an 8-hour day without constantly working through breaks or staying late?
I’m not afraid of being busy. I’m mainly trying to avoid leaving one extremely metric-driven environment only to walk into another one that’s just as difficult.
I’d really appreciate any insight from current or former Optum/UHC RN case managers — especially anyone who has worked Medicare Complex CM or has experience with both UHC/Optum and Anthem/Elevance.
Thank you!

Anyone here work with Optum complex managed medicare as an RN case manager? What is your typical day like? I was told they managed 50 cases and follow members for a few months since they are complex. I have done medicaid and commercial and commercial by far the most hectic and very intense I have done. Any input is greatly appreciated.

Anyone here work with Optum complex managed medicare as an RN case manager? What is your typical day like? I was told they managed 50 cases and follow members for a few months since they are complex. I have done medicaid and commercial and commercial by far the most hectic and very intense I have done. Any input is greatly appreciated.

I’m looking for some outside perspective because I’ve been going back and forth on this decision.
I’ve been with Elevance Health for over 10 years. During that time I’ve worked in Utilization Management and Case Management. I started in the Medicaid/Medicare side and now work in Commercial Case Management.
To be honest, my current CM role has become incredibly stressful. The metrics seem to keep increasing, everything feels heavily monitored, and the micromanagement has taken a toll on me. I actually started looking both internally and externally because I felt like I needed a change.
Ironically, everything happened at once. I received two offers:
Elevance Health: Internal transfer to Utilization Management (Concurrent Review)
UnitedHealthcare/Optum: Medicare Complex Case Manager
The UM position would let me stay with a company I already know. I understand the systems, the benefits, and the culture (for better or worse). My hope is that UM will be less stressful than my current CM role, but I know every department can be different.
The UnitedHealthcare offer is a fresh start. From what I understand, the caseload is around 40–45 members, and you typically manage them for about six months. I like the idea of starting over somewhere new, but I have no firsthand experience with UHC’s culture, management, or work-life balance.
If you were in my shoes, what would you do?
Would you stay with the company you’ve known for 10+ years and make an internal move?
Or would you take the chance on a completely new company?
If you’ve worked at either Elevance or UnitedHealthcare/Optum (especially in UM or Case Management), what was your experience with the workload, metrics, micromanagement, and overall culture?
I’m really looking for honest experiences—both the good and the bad. Thanks in advance!