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Hours Full-time, Part-time
Location Las Vegas, NV
Las Vegas, Nevada

About this job


Primary responsibility for On-Site RN Case Manager includes discharge planning, improved transitions of care, and utilization management of hospitalized health plan members.  Ensure they receive quality medical care in the most appropriate setting. 

 

Performs the following case management skills on a daily basis: 

1) Perform patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial)

2) Develop individualized discharge plans that involve provider, patient, and caregiver goals for successful transitions of care.

3) Implement discharge plan involving health care resources across the continuum

4) Monitor and report variances that may challenge timely quality care.

 

**RN Case Manager will be on-site at UMC **

 

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 Acute Hospital setting.

  • 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.

 


 


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)

Requirements


Requirements:


  • Must possess an active and current Nevada RN license

  • Associates degree or higher in Nursing

  • 3+ years of varied clinical experience in a hospital setting with an emphasis on case management or utilization management (Med/Surg background is helpful and preferred)

  • Possess knowledge of utilization management in a managed care environment. 

  • Understand spectrum of alternate delivery system.

  • Demonstrate initiative toward problem solving without direct supervision.

  • Strong organizational and computer skills.

  • Strong written and oral communication skills.

  • Good problem-solving skills.

  • Assess patient needs to coordinate appropriate level of care.

  • Ability to negotiate with professionals, patients, and caregivers.

  • Independent case management knowledge and skills to formulate plans of care without direct supervision.

Preferred Assets:


  • Case management experience preferred.

  • CCM preferred within 2 years of employment

  • Knowledge of Interqual or Milliman guidelines preferred.

  • Experience in a managed care organization preferred.  

 


Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in health care here. We serve the health care needs of low income adults and children with debilitating illnesses such as cardiovascular disease, diabetes, HIV/AIDS and high-risk pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive health care, community and government partners to heal health care and create positive change for those who need it most. This is the place to do your life's best work.SM

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.


 


key words:  RN, registered nurse, case manager, CCM, case management, Las Vegas, NV, Nevada, United Health Group, UMC