RN Complex Case Manager - Las Vegas, NV

UnitedHealth Group • Las Vegas, NV

4d • Hybrid

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 a RN Complex 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.
Candidates must be available to work Monday-Friday 8:30 am-5:00 pm and be willing to perform home and office visits locally up to 25%25 as needed.
If you reside within a commutable distance from the Las Vegas, NV area, you will have the flexibility to work remotely as you take on some tough challenges.
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
• 3+ years of adult clinical experience in a hospital, acute care or direct care setting
• 1+ years of case management experience
• Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word

Nice To Haves

• Bachelor’s degree
• CCM certification or ability to obtain within 2 years of employment
• 2+ years of case management/utilization review experience
• Experience in an IMC level or higher (i.e. ER, ICU, etc.)
• Experience in a managed care organization
• Experience in a telephonic role
• Knowledge of Interqual or Milliman guidelines (MCG)
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Responsibilities

• Performs the following case management skills on a daily basis
• Perform patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial)
• 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, lease restrictive level of care
• Utilize both company and community based resources to establish a safe and effective case management plan for members
• Collaborate with patient, family, and health care providers to develop an individualized plan of care
• 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
• Work completed in Sub-Acute facilities or Acute Hospital settings

Benefits

• In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).
• No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 5,001-10,000 employees