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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:




Approximate Salary:

Not Specified

Position Type:

Full Time

Complex Care RN Case Manager - Rancho / S. Eastern $3,000 Sign-On Bonus for External Candidates

UHG - Las Vegas, Nevada

Posted: 11/15/2018

Do you have compassion and a passion to help others?  Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)
Southwest Medical, part of OptumCare, is a multi-specialty group of physicians, Nurse Practitioners, and Physician Assistants consisting of over 300 providers, 21 medical health centers including six urgent care clinics, four convenient care centers, two lifestyle centers catering to older adults, an outpatient surgery center, home health, hospice and palliative care services, plus E-visits and online options via Now Clinic telemedicine technology. Southwest Medical offers patients compassion, innovation, and quality care throughout southern Nevada. Southwest Medical is headquartered in the greater Las Vegas, NV area.

As the Complex RN Case Manager you will be responsible for care management and coordination of care for high risk cardiac and congestive heart failure patients. You would be working in the Cardiology department. You will be working closely with the Cardiology Providers, assisting with the CHF clinic, assisting with remote telemonitoring of patients and assist management/providers to set up other clinics / programs that are of interest. The Complex RN Case Manager will have his/her own scheduled patients who come in for visits as well as those patients who will need to be reached telephonically. 
Primary Responsibilities:
  • Apply case management standards of practice to focus on effective care of high risk high need patients at a specific site
  • Serve as a patient advocate and resource and provide critical information and recommendations to the rest of the care team
  • Participates in assessment activities to develop individualized plans of care in coordination with patient, family and providers
  • Follows patient through various transitions of care to ensure that any gaps are identified and remedied and promote efficient health care delivery
  • Maintains strong knowledge of UM, Case management, community resources and plan benefits to ensure improved outcomes
  • Works collaboratively with primary care on site staff to ensure patient compliance and adherence to medical plan of care
  • Assist clinicians in implementing best practices for chronic care and disease management
  • Follow standard protocols, processes and policies to include but not limited to the following: Medication Refill, Preventative Services, Managing Conditions, and Disease Case Management as signed by department head or designee
  • Making outbound calls to assess members' current health status
  • Identifying gaps or barriers in treatment plans
  • Providing patient education to assist with self-management
  • Interacting with Medical Directors on challenging cases
  • Coordinating care for members
  • Making referrals to outside sources
  • Coordinating services as needed (home health, DME, etc.)
  • Educating members on disease processes
  • Encouraging members to make healthy lifestyle changes
  • Documenting and tracking findings
  • Utilizing Milliman criteria guideline for patient care
  • Responsible for monitoring and evaluation of electronic data received in the Telemonitoring Software Application from remote biometric monitors located in the patient’s home
  • Demonstrated ability to perform case management activities
  • Demonstrates strong clinical knowledge, ability to perform clinical assessments on Cardiology patients, ability to use critical thinking skills and has the capacity for continued learning
  • Knowledge of UM and plan benefit designs
  • Ability to demonstrate knowledge of and apply those to the job function and responsibilities
  • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

 Required Qualifications: 
  • Current, unrestricted NV RN license or temporary NV RN license with the ability to obtain permanent NV RN license upon expiration of temporary NV RN license
  • 3+ years of clinical nursing experience with direct patient care in an acute care setting (preferably Critical Care, general ICU, ER) 
  • 1+ years of Case Management experience
Preferred Qualifications: 
  • Certification in Case Management and / or complex disease management
  • Strong telemetry/EKG experience (able to read and interpret cardiac telemetry rhythms)
  • Medicaid, Medicare, Managed Care experience
  • Experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs
  • Bilingual skills
  • Experience in Home & Community based or Long Term Care services delivery
  • Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software application 
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
 **PLEASE NOTE** The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis (“Internal Candidates”) are not eligible to receive a sign on bonus.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. 
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: RN Case Manager-Cardiology, critical care, Las Vegas, NV, Nevada

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