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 an On - Site RN Case Manager, you'll be making a difference in peoples' lives and will be responsible for discharge planning, improved transitions of care, and utilization management of hospitalized health plan members. You will ensure patients receive quality medical care in the most appropriate setting. 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. Here, we're working to help others live healthier lives while providing an opportunity for you to do your life's best work.(sm) Performs the following case management skills on a daily basis: Perform patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial) Develop individualized discharge plans that involve provider, patient, and caregiver goals for successful transitions of care Implement discharge plan involving health care resources across the continuum Monitor and report variances that may challenge timely quality care **RN Case Manager will be on - site at various locations and RN Case Manager must be flexible to float and work in various locations around Las Vegas and Henderson area.** Primary 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 Sub - Acute facilities or Acute Hospital settings 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
Required Qualifications:Must possess an active and current Nevada RN license 3+ years of varied clinical experience in a hospital setting ideally with an emphasis on case management or utilization management (with at least 2 of those years in acute care Independent case management knowledge and skills to assess and formulate plans of care without direct supervisionPreferred Qualifications:Case management experience Experience in a critical care unit BSN CCM preferred or obtained within 2+ years of employment Possess knowledge of utilization management in a managed care environment Knowledge of Interqual or Milliman guidelines Experience in a managed care organization 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. Job Keywords: RN, registered nurse, case manager, CCM, case management, UM, inpatient, critical care, ICU, acute, utilization management, UR, utilization review, Interqual, Milliman, MCG, managed care, Las Vegas, NV, Nevada, UHG, United Health Group, UnitedHealth Group
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.