Description

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

As the RN Case Manager you are responsible for the Utilization Management and coordination of Case Management services for members hospitalized in acute/subacute settings outside the service area. Case managers 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 various 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.

*** Candidates must be available to work Monday - Friday from 8:00 am - 5:00 pm. ***

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Making outbound calls to assess members' current health status
• Utilizing InterQual criteria to determine if patients are in the correct hospital setting
• Coordination of member's care through the health care continuum
• Collaborate with the member, provider, & the facility to obtain the best outcome
• Collaborate with members of the health care team, to include attending physicians, hospital Utilization Management teams, Home Health agencies, Sub-acute care teams, Durable Medical Equipment teams, PCP's, internal UM and CM teams and the health plan Medical Director.
• Complete cost - benefit analysis as appropriate
• Identifying gaps or barriers in treatment plans
• Review cases with Medical Directors daily on challenging cases and as needed
• Making referrals to outside sources
• Documenting and tracking findings

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 license RN license in the state of Nevada
• 2+ years of acute clinical experience
• Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word and Excel
• Ability to obtain additional license as required

Preferred Qualifications:

• Bachelor's degree in Nursing
• Case management in a managed care environment
• Knowledge and/or experience with InterQual
• Previous med-surg, telemetry, pediatric and/or critical care experience
• Utilization review experience in an acute/sub-acute setting
• Proven knowledge of CMS and other regulatory agencies
• Excellent inbound and outbound telephonic skills

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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