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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.When you join us as a RN Nurseline Case Manager, you'll be making a difference in peoples' lives by offering telephonic support and assistance to members seeking health education, program referrals or general health services. You will work with patients to manage their health conditions for ultimate outcomes by taking in-bound calls and placing out-bound calls as dictated by consumer and business needs.In this role you will provide telephonic triage and nurse advice based on protocols as well as various case management activities to include discharge planning, improved transitions of care and utilization management of health plan members. Ensure members receive quality medical care in the most appropriate setting.If you are located within a commutable distance from Las Vegas, NV, you will have the flexibility to work remotely 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 members are directed to the most 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 (MCG) to assess and determine appropriate level of care for members
Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
This department is open 24/7. Candidates must be available to work a 5 PM - 3:30 AM shift 20 hours per week. This department works a rotation of weekends and holidays.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
Basic to intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word
Willing and able to work rotating weekends and holidays
Preferred Qualifications:
Bachelor’s degree
CCM certification
Experience in discharge planning and/or case management
Experience in a managed care organization
Exceptional knowledge in triage and assessment
Possess knowledge of utilization management in a managed care environment
Knowledge of MCG
Understand spectrum of alternative delivery system
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyNevada Residents Only: The hourly range for Nevada residents is $50.34 to $91.54 per hour. 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.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.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer 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.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
