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UnitedHealth Group RN Manager Case Management SMA Las Vegas in Las Vegas, Nevada

$7500 Sign On Bonus for External Candidates

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

Primary Responsibilities:

  • Ensures staff are developing plans to avoid readmissions and provide the highest quality of service with the patients

  • Oversight of day to day RN Case Management functions including training, 1:1’s, and delegation of responsibilities to ensure business continuity

  • Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit

  • Staffing 7 days a week including Holidays. Delegates responsibilities as required

  • Managing resources to achieve overall company and department strategic objectives and financial goals

  • Coordination with Quality Improvement and Assurance for audits and annual IRR’s

  • Facilitate patient/family, provide communications as indicated, and advocate for patient/family with healthcare team as needed

  • Communicate with stakeholders, appropriate health care related information to ensure timely coordination of care and services for patients currently receiving inpatient care; identify point of contact for management transitions of care

  • Utilizes approved clinical criteria to assess and determine appropriate level of care for patients currently receiving inpatient care

  • Acts as a project coordinator in coordination with the ACE Team for new medical management processes to improve the care of the patients as required

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:

  • Current, unrestricted NV RN license or temporary NV RN license with the ability to obtain permanent NV RN license upon expiration of temporary NV RN license

  • 5+ years of clinical experience in hospital setting or post-acute care with emphasis in case management and utilization management

  • 1+ years of management experience in an acute setting or in a rehabilitation setting

  • Knowledge of utilization management, case management and discharge planning

  • Competent understanding of Medicare requirements in Hospital, home care and hospice regulations

  • Basic understanding of insurance products, benefits, coverage limitations, laws and regulations as it applies to the health plan

  • Proficiency in Microsoft Office (e.g. Word, Excel, PowerPoint, Outlook) and other clinical software systems

  • Reliable transportation and flexible to travel to local facilities as needed within the Las Vegas area

  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Preferred Qualifications:

  • CCM

  • Proficient in Milliman or Interqual

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Keywords: RN Manager, Manager of Case Management, Case Management, RN, Las Vegas, NV, Nevada

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