RN Complex Case Manager - Las Vegas, NV
Company: UnitedHealthcare
Location: Las Vegas
Posted on: May 15, 2025
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Job Description:
$10,000 Sign-on Bonus for External Candidates
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At UnitedHealthcare, we're simplifying the health care experience,
creating healthier communities and removing barriers to quality
care. The work you do here impacts the lives of millions of people
for the better. Come build the health care system of tomorrow,
making it more responsive, affordable and equitable. Ready to make
a difference? Join us to start Caring. Connecting. Growing
together.
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 Complex Case
Manager, you'll be making a difference in peoples' lives and will
be responsible for discharge planning, improved transitions of
care, and utilization management of hospitalized health plan
members. You will ensure patients receive quality medical care in
the most appropriate setting. -
-** Candidates must be available to work Monday-Friday 8:30 am-5:00
pm and be willing to perform home and office visits locally up to
25% as needed. **
If you reside within a commutable distance from the Las Vegas, NV
area, you will have the flexibility to work remotely* as you take
on some tough challenges. -
Primary Responsibilities:
Performs the following case management skills on a daily basis:
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Perform patient assessment of all major domains using evidence
based criteria (physical, functional, financial and psychosocial)
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Monitor and report variances that may challenge timely quality care
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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 members -
Collaborate with patient, family, and health care providers to
develop an individualized plan of care -
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 -
Provides health education and coaches consumers on treatment
alternatives to assist them in best decision making -
Supports consumers in selection of best physician and facility to
maximize access, quality, and to manage heath care cost -
Coordinates services and referrals to health programs -
Prepares individuals for physician visits -
Assesses and triages immediate health concerns -
Manages utilization through education -
Identifies problems or gaps in care offering opportunity for
intervention -
Assists members in sorting through their benefits and making
choices -
Takes in-bound calls and places out-bound calls as dictated by
consumer and business needs -
Special projects, initiatives, and other job duties as assigned
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Work completed in Sub-Acute facilities or Acute Hospital settings
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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.Required
Qualifications:
Registered Nurse with active unrestricted license in the State of
Nevada -
3+ years of adult clinical experience in a hospital, acute care or
direct care setting
Intermediate level of proficiency using a PC in a Windows
environment, including Microsoft Word -
Preferred Qualifications:
Bachelor's degree -
CCM certification or ability to obtain within 2 years of
employment
2+ years of case management/utilization review experience
Experience in an IMC level or higher (i.e. ER, ICU, etc.)
Experience in a managed care organization -
Experience in a telephonic role
Knowledge of Interqual or Milliman guidelines (MCG)
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy -
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The salary range for this role is $59,500 to $116,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
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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.
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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.
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UnitedHealth Group is a drug - free workplace. Candidates are
required to pass a drug test before beginning employment.
Keywords: UnitedHealthcare, Sunrise Manor , RN Complex Case Manager - Las Vegas, NV, Executive , Las Vegas, Nevada
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