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 Nurseline Case Manager, you'll be making a difference in peoples' lives by offering telephonic support and assistance to members seeking health education, program referrals or general health services. You will work with patients to manage their health conditions for ultimate outcomes by taking in-bound calls and placing out-bound calls as dictated by consumer and business needs. 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) In this role you will provide telephonic triage and nurse advice based on protocols as well as various case management activities to include discharge planning, improved transitions of care and utilization management of health plan members. Ensure members receive quality medical care in the most appropriate setting. ***This department is open 24/7. This role will be 4-10 hour shifts either at 12:30pm-11pm or 2pm-12:30am.******This department works a rotation of weekends and holidays*** Primary Responsibilities: Perform thorough telephonic nursing assessment and clinical review to determine appropriate triage protocol to utilize for nurse care advice. Ensure members are directed to the most appropriate level of care at contracted facilities Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, least 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 member, 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 members Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team Utilize approved clinical criteria (MCG) to assess and determine appropriate level of care for members Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
Required Qualifications:Registered Nurse with active unrestricted license in the State of Nevada 2+ years of varied clinical experience in a hospital setting Basic to intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word Willing and able to work rotating weekends and holidays Preferred Qualifications: Bachelor's degree CCM certification Exceptional knowledge in triage and assessment Experience in discharge planning and/or case management Experience in a managed care organization Possess knowledge of utilization management in a managed care environment Knowledge of MCG Understand spectrum of alternative delivery systemCareers 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: RN, registered nurse, nurse line, triage, telephonic nursing, claims, MCG, Millimans, appeals, grievances, case management, CCM, medical adjudication, prior authorizations, utilization review, case management, discharge planning, Las Vegas, NV
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.