Remote Advice Nurse – Case Manager

UnitedHealthcare

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Requisition Number: 2223625
Job Category: Nursing
Primary Location: Las Vegas, NV
(Remote considered)

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.  

Primary responsibility is to provide telephonic triage and nurse advice based on nationally recognized protocols as well as various case management activates to include discharge planning, transitions of care, care coordination, and utilization management of health plan members. Ensure members receive quality medical care in the most appropriate setting.

If you are located in Las Vegas, NV, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges.

Primary Responsibilities: 

  • Perform thorough telephonic nursing assessment and clinical review to determine appropriate triage protocol to utilize for nurse care advice. Ensure member is directed to 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 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 pla

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications: 

  • Registered Nurse with active, unrestricted license in the state of Nevada
  • 2+ years of varied clinical experience in a hospital setting
  • Knowledge of utilization management in a managed care environment
  • Understand spectrum of alternative delivery system
  • Exceptional knowledge in triage and assessment
  • Demonstrated initiative toward problem solving without direct supervision

Preferred Qualifications:

  • Bachelor’s degree
  • CCM
  • Experience in managed care organization
  • Case management experience
  • Knowledge Milliman Care Guidelines (MCG)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Nevada Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.