[Hiring] Telephone Triage RN Case Manager - 10K Sign On Bonus for External Candidates @UnitedHealth Group

Role Description

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 in 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 flexible schedule 11:00 am – 9:30 pm 4 days 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.

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.

Requirements

• Bachelor’s degree.
• ACM or CCM certification.
• Exceptional knowledge in triage and assessment.
• Experience in discharge planning and/or case management.
• Experience in a managed care organization.
• Possess knowledge of utilization management in a managed care environment.
• Knowledge of MCG.
• Understand spectrum of alternative delivery system.

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.

Company Description

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.