Part-Time Telephone Triage RN Case Manager - Las Vegas, NV

UnitedHealth Group•Las Vegas, NV

1d•$29 - $52•Remote

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. When you join us as a RN Nurseline Case Manager, you'll be making a difference in peoples' lives by offering telephonic support and assistance to members seeking health education, program referrals or general health services. You will work with patients to manage their health conditions for ultimate outcomes by taking in-bound calls and placing out-bound calls as dictated by consumer and business needs. In this role you will provide telephonic triage and nurse advice based on protocols as well as various case management activities to include discharge planning, improved transitions of care and utilization management of health plan members. Ensure members receive quality medical care in the most appropriate setting. If you are located in Las Vegas, NV, you will have the flexibility to telecommute 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
2+ years of varied clinical experience in a hospital setting
Basic to intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word
Willing and able to work rotating weekends and holidays

Nice To Haves

Bachelor’s degree
ACM or CCM certification
Exceptional knowledge in triage and assessment
Experience in discharge planning and/or case management
Experience in a managed care organization
Possess knowledge of utilization management in a managed care environment
Knowledge of MCG
Understand spectrum of alternative delivery system

Responsibilities

Perform thorough telephonic nursing assessment and clinical review to determine appropriate triage protocol to utilize for nurse care advice. Ensure members are directed to the most appropriate level of care at contracted facilities
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 member, 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 members
Advocate for members and families as needed to ensure the member’s needs and choices are fully represented and supported by the health care team
Utilize approved clinical criteria (MCG) to assess and determine appropriate level of care for members
Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan