RN Case Manager - Field And Office Based - Las Vegas, NV

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. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. This is the place to do your life's best work.(sm)
 
As part of the Neighborhood Care Team the Neighborhood RN Case Manager works collaboratively with their assigned Neighborhood Medical Director and Interdisciplinary care team to assess and manage the overall patient care process. The position will ensure the execution of innovative actions to meet the needs of the primary care for complex Community based program patients with in their neighborhood assignment.  He / she will participate in interdisciplinary meetings to create plans of care that identify medical, psychosocial, and socioeconomic dimensions of care and then assist to assign the right level of care and employee to the interventions. The position will continually assess the level of the management needed for the patient and focus on meeting the patient’s needs with the best resource on the Neighborhood Care Team.  This assessment evaluation will require home visits, supervisor evaluation of competencies or peer evaluation of practices. The Neighborhood RN Care Manager will ensure that all pertinent documentation is in the medical record in a manner compliant to policy.
 
Primary Responsibilities:

Participates in program development with the Executive Leadership Team (Medical Directors and Operations Leaders) to ensure a unified approach to case management, and to optimize the continuity of care for patients in the Neighborhood
Meet with Neighborhood team weekly to review patient progress in medical treatment.  Identify patients that will require a physician visit and determine with the RN Coordination Manager if the assigned IDT resources are working towards optimal performance
Develop neighborhood plans of care that incorporate medical, social, emotional and life planning goals in order to reduce unnecessary burden of illness for the patient and assist to guide them to the next level of transitions of care
Evaluate weekly metrics on completion of required home care compliance, RAF, HEDIS and complaints in the neighborhood
Provide the clinical staff with ongoing clinical education/updates to enhance understanding of acute and chronic medical conditions and follow evidence based medicine
Participates in the development of outcome measurement tools and statistical reports to monitor effectiveness of the Primary Care for Complex Community Based program system.  The emphasis of this position is to focus on clinical outcome of the patient’s assigned to the neighborhood
Ensure task completion, medication refill orders and provider directed home care orders are completed within LEAN standard goals and as per Optum approved nursing approved protocols
Ensure and document patient goals of care, progress notes and other record requirements in the electronic medical record
Oversees the personnel assigned to the neighborhood and complete annual and periodic performance reviews to include successful productivity standards, bonus criteria, patient satisfaction and positive outcome measurements
Collaborate with the operational team to assist in hiring, disciplinary action and competencies of the team members in the neighborhood
Review RCC call logs and notes on patient activities of the neighborhood patients
Performs duties within state and federal regulatory guideline, Optum / United policy and in accordance to scope of practice
Provide the clinical staff with on-going clinical education / updates to enhance understanding of acute and chronic medical conditions and follow evidence based medicine
 Other duties assigned to for program meetings / task forces in accordance with job description

Required Qualification:

Bachelor’s degree in nursing
Active unrestricted Nevada RN license by the Nevada State Board of Nursing
Knowledge of insurance products lines of business
Strong knowledge of the community health care environment, the provider network and the managed care contracting processes
Good understanding of managed care systems, quality improvement and risk management
Demonstrated excellent clinical management, leadership skills and communication skills
Minimum of 5 years of medical experience
 
Preferred Qualifications:

Comprehensive knowledge of medical management principles for case management
Preferred CCM certification
Minimum of 1-2 years experience in home care
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)
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, registered nurse, case manager, CCM, Las Vegas, NV, United Health Group, Optum