1+ months

Onsite Telephone RN Case Manager Las Vegas

Las Vegas, NV 89101
  • Job Code
  • Jobs Rated
Are you ready for your next challenge? Discover it here at UnitedHealth Group and help us reinvent the health system. We're going beyond basic care, providing integrated health programs with a member-centric focus. The challenge is ensuring we deliver the right care at the right time. When you join us as a RN Case Manager, you'll be making a difference in peoples' lives by offering support and assistance to members seeking health education, program referrals or general health services. You will work with patients to manage their health conditions as dictated by consumer and business needs.
As the RN Case Manager you are responsible for the management and coordination of Case Management services for members hospitalized in acute / subacute settings. As the Case manager you will work directly with Out-of-Area, Reno, Rural Nevada, and Las Vegas members, providers(s), and facility to ensure the most appropriate care is provided. The Case Manager will assess, plan, implement, coordinate, monitor, and evaluate 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.
Primary Responsibilities:
  • Making outbound calls to assess members' current health status
  • Utilizing Milliman criteria to determine if patients are in the correct hospital setting
  • Coordination of member's care through the health care continuum
  • Collaborate with member, provider, facility to obtain best outcome
  • Utilize both company and community based resources to establish a safe and effective case management plan for hospitalized members
  • Complete cost-benefit analysis as appropriate
  • Identifying gaps or barriers in treatment plans
  • Review and present cases to Medical Directors
  • Making referrals to outside sources
  • Documenting and tracking findings
  • Evaluate member needs for transitional care program referrals
  • Compose clinical correspondence (level of care determinations and denials) for members and providers



Jobs Rated Reports for Registered Nurse

Posted: 2020-01-10 Expires: 2020-02-23

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Onsite Telephone RN Case Manager Las Vegas

UnitedHealth Group
Las Vegas, NV 89101

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Registered Nurse
118th2018 - Registered Nurse
Overall Rating: 118/220
Median Salary: $70,000

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