RN Case Manager
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Primary responsibility for On-Site RN Case Manager includes discharge planning, improved transitions of care, and utilization management of hospitalized health plan members. Ensure they receive quality medical care in the most appropriate setting. Performs the following case management skills on a daily basis: 1) perform patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial); 2) develop individualized discharge plans that involve provider, patient, and caregiver goals for successful transitions of care.; 3) implement discharge plan involving health care resources across the continuum; and 4) monitor and report variances that may challenge timely quality care.
Responsibilities:
- 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 hospitalized members.
- Collaborate with patient, 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 hospitalized 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.
- Utilize approved clinical criteria to assess and determine appropriate level of care for hospitalized members.
- Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan.
- Accountable to understand role and how it affects utilization management benchmarks and quality outcomes.
Requirements:
- Must possess an active and current Nevada RN license
- Associates degree or higher in Nursing
- 2+ years of varied clinical experience in a hospital setting with an emphasis on case management or utilization management (Med/Surg background is helpful and preferred)
- Possess knowledge of utilization management in a managed care environment.
- Understand spectrum of alternate delivery system.
- Demonstrate initiative toward problem solving without direct supervision.
- Strong organizational and computer skills.
- Strong written and oral communication skills.
- Good problem-solving skills.
- Assess patient needs to coordinate appropriate level of care.
- Ability to negotiate with professionals, patients, and caregivers.
- Independent case management knowledge and skills to formulate plans of care without direct supervision.
Preferred Assets:
- Case management experience preferred.
- CCM preferred within 2 years of employment
- Knowledge of Interqual or Milliman guidelines preferred.
- Experience in a managed care organization preferred.
UnitedHealthcare Employer Individual is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare Employer Individual, what you do matters. It's that simple...and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Regardless of your role at UnitedHealthcare Employer Individual, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
