Inpatient RN Case Manager - Las Vegas, NV

UnitedHealth Group • Las Vegas, NV

95d • $28 - $50 • Onsite

About The Position

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Are you ready for your next challenge? Discover it here at UnitedHealth Group and help us reinvent the health system. We're going beyond basic care, providing integrated health programs with a member-centric focus. The challenge is ensuring we deliver the right care at the right time. When you join us as an Inpatient RN Case Manager, you'll be making a difference in peoples' lives and will be responsible for discharge planning, improved transitions of care, and utilization management of hospitalized health plan members. You will ensure patients receive quality medical care in the most appropriate setting.

Requirements

• Registered Nurse with active, unrestricted license in the State of Nevada
• 2+ years of adult clinical, managed care, or case management experience
• Intermediate level of proficiency using a PC in a Windows environment, including MS Word and Excel
• Driver's license and access to reliable transportation

Nice To Haves

• CCM certification or ability to obtain within 2+ years of employment
• 2+ years of ER, ICU, IMC/stepdown or med-surg experience
• Case management/utilization review experience
• Experience in a managed care organization
• Knowledge of Interqual or MCG

Responsibilities

• Perform patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial)
• Develop individualized discharge plans that involve provider, patient, and caregiver goals for successful transitions of care
• Implement discharge plan involving health care resources across the continuum
• Monitor and report variances that may challenge timely quality care
• Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care
• Utilize both company and community based resources to establish a safe and effective case management plan for hospitalized members
• Collaborate with patient, family, and health care providers to develop an individualized plan of care that encompasses both acute care episode and post hospital discharge plan
• Communicate with all stakeholders the required health related information to ensure quality coordinated care and services are provided expeditiously to all hospitalized members
• Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
• Utilize approved clinical criteria to assess and determine appropriate level of care for hospitalized members
• Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
• Accountable to understand role and how it affects utilization management benchmarks and quality outcomes
• Provides health education and coaches consumers on treatment alternatives to assist them in best decision making
• Supports consumers in selection of best physician and facility to maximize access, quality, and to manage health care cost
• Coordinates services and referrals to health programs
• Prepares individuals for physician visits
• Assesses and triages immediate health concerns
• Manages utilization through education
• Identifies problems or gaps in care offering opportunity for intervention
• Assists members in sorting through their benefits and making choices
• Takes in-bound calls and places out-bound calls as dictated by consumer and business needs
• Special projects, initiatives, and other job duties as assigned
• Work completed in Sub - Acute facilities or Acute Hospital settings
• Occasional driving up to one (1) hour daily for regular employees per diem employees will drive less than one hour daily and are not subject to the driving requirements

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Insurance Carriers and Related Activities
• Education Level: Bachelor's degree