For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
As the RN Case Manager you are responsible for the management and coordination of Case Management services for members hospitalized in acute/subacute settings outside the service area. Case manager works directly with the member, providers(s), facilities and other entities to ensure the most appropriate care is provided. The Case Manager manages members from all fully funded product lines. The Case Manager assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the member's health needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost - effective interventions and outcomes.
Candidates must be available to work Monday – Friday 8:00 am – 5:00 pm from our office located at 2716 N Tenaya in Las Vegas, NV.
- Making outbound calls to assess members' current health status
- Utilizing Milliman criteria to determine if patients are in the correct hospital setting
- Coordination of member's care through the health care continuum
- Collaborate with member, provider, facility to obtain best outcome
- Collaborate with internal members of the health care team, to include PCP, FHS, COC and Medical Director
- Complete cost - benefit analysis as appropriate
- Identifying gaps or barriers in treatment plans
- Review cases with Medical Directors daily on challenging cases as needed
- Making referrals to outside sources
- Documenting and tracking findings
- Current, unrestricted license RN license in the State of Nevada
- 1+ years of acute clinical experience
- Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word and Excel
- Bachelor's degree in Nursing
Case management in a managed care environment
Utilization review experience in an acute/sub-acute setting
Strong knowledge of CMS and other regulatory agencies
Strong inbound and outbound telephonic skills
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.
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