Inpatient RN Case Manager - Las Vegas, NV

UnitedHealth Group•Henderson, KY

12h•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 optimized. 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. 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. 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.

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

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 heath 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