RN Complex Case Manager - Las Vegas, NV

UnitedHealthcare; Carthage (MO); Remote; USD 59,000 - 117,000; Full time

Job summary

Join a leading health care organization as an RN Complex Case Manager, where you'll manage care transitions and ensure quality care for hospitalized members. This role offers the chance to make a significant impact on patients' lives while working in a supportive environment with opportunities for growth.

Benefits

Comprehensive Benefits

Incentive Programs

Stock Purchase Options

401(k) Contributions

Qualifications

• Active RN license in Nevada.
• 3 years of adult clinical experience in hospital or acute care settings.

Responsibilities

• Perform patient assessments using evidence-based criteria.
• Collaborate with patients and providers to develop care plans.
• Manage utilization through education and intervention.

Skills

Clinical Experience

Communication

Advocacy

Education

Bachelor's Degree

Tools

Microsoft Word

Job description

$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 impacts the lives of millions. Join us to build a more responsive, affordable, and equitable health care system. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Discover your next challenge at UnitedHealth Group, where we go beyond basic care to provide integrated, member-centric health programs. As an RN Complex Case Manager, you'll make a difference in people's lives by managing discharge planning, care transitions, and utilization of hospitalized health plan members, ensuring they receive quality care in appropriate settings.

Candidates must be available to work Monday-Friday 8:30 am-5:00 pm and willing to perform local home and office visits up to 25% as needed. If you reside near Las Vegas, NV, you will have the flexibility to work remotely, subject to company policies.

Primary Responsibilities:

1. Perform patient assessments across major domains using evidence-based criteria.
2. Monitor and report variances affecting timely, quality care.
3. Develop and implement individualized care strategies aimed at least restrictive care levels.
4. Utilize resources to establish effective case management plans.
5. Collaborate with patients, families, and providers to develop care plans.
6. Communicate health-related information to ensure coordinated care.
7. Advocate for patients and families to support their needs and choices.
8. Assess and determine appropriate care levels using clinical criteria.
9. Understand insurance benefits, coverage, and regulations.
10. Contribute to utilization management benchmarks and quality outcomes.
11. Provide health education and coaching on treatment options.
12. Assist members in selecting providers and managing healthcare costs.
13. Coordinate services and referrals to health programs.
14. Prepare individuals for physician visits and triage health concerns.
15. Manage utilization through education and intervention.
16. Identify care gaps and opportunities for intervention.
17. Assist members with benefits and choices.
18. Handle inbound and outbound calls as needed.
19. Participate in special projects and initiatives.
20. Work in sub-acute or acute hospital settings.

We offer a rewarding environment with opportunities for growth, clear success metrics, and development pathways.

Required Qualifications:

1. Active, unrestricted Registered Nurse license in Nevada.
2. At least 3 years of adult clinical experience in hospital, acute care, or similar settings.
3. Proficiency in Windows and Microsoft Word.

Preferred Qualifications:

1. Bachelor's degree.
2. CCM certification or ability to obtain within 2 years.
3. Over 2 years of case management or utilization review experience.
4. Experience in IMC or higher levels of care.
5. Experience in managed care and telephonic roles.
6. Knowledge of Interqual or Milliman guidelines.

*Remote employees must adhere to UnitedHealth Group's Telecommuter Policy.

The salary range is $59,500 to $116,600 annually, based on full-time employment, experience, education, and other factors. We offer comprehensive benefits, incentive programs, stock purchase options, and 401(k) contributions. Join us to enjoy a broad range of benefits and opportunities.

Our mission is to help people live healthier lives and improve the health system for all. We are committed to equity, environmental responsibility, and addressing health disparities, especially for marginalized groups.

UnitedHealth Group is an Equal Employment Opportunity employer. All qualified applicants will be considered without regard to race, gender, age, or other protected characteristics. We are a drug-free workplace requiring a pre-employment drug test.