UHG

About UHG

Careers at UnitedHealth Group

 

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:

Nurse

Country:

US

Approximate Salary:

Not Specified

Position Type:

Full Time

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RN Complex Case Manager - Las Vegas, NV - $1500 Sign On Bonus For External Candidates

UHG - Las Vegas, Nevada

Posted: 11/12/2018

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.


What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Here, we're working to help others live healthier lives while providing an opportunity for you to do your life's best work.(sm)


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)

  • 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

 Candidates must be available to work Monday - Friday 8:30 am - 5:00 pm from our office located at 2716 N Tenaya in Las Vegas, NV.  Must be willing to perform home and office visits as needed.

 

Primary Responsibilities:

  • 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 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

  • 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


Required Qualifications:

  • Registered Nurse with active unrestricted license in the State of Nevada
  • 3+ years of clinical experience
  • Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word

Preferred Qualifications:

  • Bachelor’s degree

  • Previous experience in an IMC level or higher (ie ER, ICU, etc)

  • CCM certification or ability to obtain within 2 years of employment

  • 2+ years case management/utilization review experience
  • Knowledge of Interqual or Milliman guidelines (MCG) 
  • Experience in a managed care organization

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)

 

 

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:  Registered Nurse, RN, Nurse, Case Manager, ER, IMC, Med-surg, ICU, Claims, MCG, Milliman, Appeals, Grievances,  CCM, Medicaid , Public Health,  Care Coordination, Case Management, Utilization Review, Prior Authorization, Discharge Planning, Medical Adjudication, Managed Care, Las Vegas, NV, Nevada, UHG, UnitedHealth Group, UHC, UnitedHealthcare

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