[Hiring] NICU Case Manager @UnitedHealth Group

Role Description

As an NICU RN Case Manager at UnitedHealthcare, you'll be responsible for:

• Discharge planning, improved transitions of care, and utilization management of hospitalized health plan members.
• Ensuring patients receive quality medical care in the most appropriate setting.

Performs the following case management skills on a daily basis:

• Perform patient assessment of all major domains using evidence-based criteria (physical, functional, financial, and psychosocial).
• Develop individualized discharge plans that involve provider, patient, and caregiver goals for successful transitions of care.
• Implement discharge plan involving health care resources across the continuum.
• Monitor and report variances that may challenge timely quality care.

If you reside within the Las Vegas, NV area, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• 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 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.

Qualifications

• Registered Nurse with active, unrestricted license in the State of Nevada.
• 2+ years of NICU clinical experience.
• Exceptional knowledge in NICU and assessment.
• Intermediate level of proficiency using a PC in a Windows environment, including MS Word and Excel.

Requirements

• CCM certification or ability to obtain within 2 years of employment.
• Case management/utilization review experience.
• Experience in a managed care organization.
• Knowledge of Interqual or MCG.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).
• Hourly pay for this role will range from $28.94 to $51.63 per hour based on full-time employment.