Remote Hybrid Pediatric RN Case Manager – Las Vegas, NV

Requisition Number: 2175058
Job Category: Nursing
Primary Location: Las Vegas, NV
(Remote considered)

$10,000 Sign On Bonus for External Candidates

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 and start doing your life’s best work.(sm)

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 Complex 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.

** Candidates must be available to work Monday-Friday 8:30 am-5:00 pm and be willing to perform home and office visits as needed. **

If you are located within a commutable distance from the Las Vegas, NV area, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Meets with member in their home or at their providers’ office, if requested, deemed appropriate, or warranted
• 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
• 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
• Monitor and report variances that may challenge timely quality care
• 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 healthcare members
• Collaborate with patient, family, and health plan 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 health plan 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
• Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
• 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
• Assess and triages immediate health concerns
• Manages utilization through education
• Identifies problems or gaps in care offering opportunity for intervention
• 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

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 Neonatal and/or Pediatric clinical experience
• Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word
• Ability to travel up to 25%

Preferred Qualifications:

• Bachelor’s degree
• CCM certification or ability to obtain within 2 years of employment
• 2+ years of case management/utilization review experience
• 2+ years of Neonatal intensive care and/or Pediatric Intensive care units experience
• Obstetric experience
• Experience in a managed care organization
• Knowledge of Interqual or Milliman guidelines (MCG)

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)

Nevada Residents Only: The salary range for Nevada residents is $56,300 to $110,400. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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

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