RN Case Manager - Office based Tenaya, Las Vegas, NV - Full-time / Part-time

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. Whether in-person or over-the-phone, we’re working to help others live healthier lives while providing an opportunity for you to do your life's best work.(sm) 
 
Southwest Medical Associates (SMA) 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, plus E-visits and online options via Now Clinic telemedicine technology.  SMA offers patients compassion, innovation, and quality care throughout southern Nevada. SMA is headquartered in the greater Las Vegas, NV area.
 
Primary Responsibilities:


Responsible for utilization management of hospitalized health plan members, discharge planning and collaboration with discharge planning

Work collaboratively with community partners, plan members and Managed Care interdisciplinary team

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

Perform patient assessment of all major domains using evidence based criteria

Assess, plan and implement care strategies that are individualized by patient and directed toward most appropriate, lease restrictive level of care

Utilize both company and community based resources to establish safe and effective case management plan for hospitalized members

Collaborate with patient, family and health care providers to develop individualized plans of care that encompasses both acute care episode and post hospital discharge plan

Advocate for patients and families as needed to ensure patients’ needs and choices are fully represented and supported by health care teamOther responsibilities as assigned

Required Qualifications:


Active, unrestricted RN license in state of Nevada

2+ years nursing experience in a hospital or clinic setting

Microsoft Office proficiency

Proficiency working in various EMRs
 Preferred Qualifications:


CCM

Case management experience

Utilization review experience

Managed care experience

Knowledge of Milliman or Interqual guidelines
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, case manager, case management, nurse, hospital, CCM, utilization review, utilization management, MCG, Milliman, Interqual, managed care, health insurance, Las Vegas, Nevada, NV