[Hiring] Out of Area RN Case Manager @UnitedHealth Group

Role Description

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 work 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.

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

*** 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.

Qualifications

• Current, unrestricted 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

Requirements

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

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

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.