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) Apply for this position with your eyes wide open. Click here to view the Realistic Job Preview: http://uhg.hr/Field_Based_Case_Manager_UHCCS As the RN Case Manager you are responsible for the management and coordination of Case Management services for members hospitalized in acute / subacute settings outside the service area. Case manager works directly with the member, providers(s), facilities and other entities to ensure the most appropriate care is provided. The Case Manager manages members from all fully funded product lines. The Case Manager assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet the member's health needs. It is characterized by advocacy, communication, and resource management and promotes quality and cost - effective interventions and outcomes. Primary Responsibilities:Making outbound calls to assess members' current health status Utilizing Milliman criteria to determine if patients are in the correct hospital setting Coordination of member's care through the health care continuum Collaborate with member, provider, facility to obtain best outcome Collaborate with internal members of the health care team, to include PCP, FHS, COC and Medical Director Complete cost - benefit analysis as appropriate Identifying gaps or barriers in treatment plans Review cases with Medical Directors daily on challenging cases as needed Making referrals to outside sources Documenting and tracking findings
Required Qualifications:Current, unrestricted RN licensure in the state of Nevada Nursing degree or equivalent 3+ years of Clinical RN acute experience, resulting in excellent clinical skills and judgment 2+ years of experience in case management in a managed care environment and / or utilization review experience in an acute/sub-acute setting Critical thinking skills as a case manager and able to formulate innovative plan of care for complex cases Strong knowledge of CMS and other regulatory agencies Intermediate level of proficiency with written and verbal communication skills Basic level of experience with Microsoft Word, with the ability to navigate a Windows environment Intermediate or expert level of proficiency with being able to assess and identify needs and being able to influence and motivate Understanding of change and ability to move members along the continuum of change Expert conflict management skills Able to work under pressure and appropriately prioritize responsibilitiesPreferred Qualifications:Bachelor's degree in Nursing CCM Coaching and / or decision support experience Strong inbound and outbound telephonic skills, or ability to quickly learn 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, Las Vegas, Nevada, NV, utilization review, telephonic, LV, case management, case management, managed care
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.