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Pediatric Case Manager RN Registered Nurse - Telecommute in Las Vegas, NV

Company: UnitedHealth Group
Location: Miami
Posted on: September 24, 2022

Job Description:

$10,000 Sign-On Bonus for External Candidates UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) 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 8:00 -am-5:00 pm and be willing to perform home and office visits as needed. ** If you are located in Las Vegas, NV, you will have the flexibility to telecommute* as you take on some tough challenges. - Primary Responsibilities: -

  • Meets with member in their home or at their providers' office, if requested, deemed appropriate, or warranted
  • 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
  • Monitor and report variances that may challenge timely quality care -
  • 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 healthcare members
  • Collaborate with patient, family, and health plan 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 health plan 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 -
  • 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 -
  • Assess and triages immediate health concerns
  • Manages utilization through education -
  • Identifies problems or gaps in care offering opportunity for intervention -
  • 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 - 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 -
    • 2+ years of Neonatal and/or Pediatric clinical experience -
    • Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word -
    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation Preferred Qualifications:
      • Bachelor's degree -
      • CCM certification or ability to obtain within 2 years of employment
      • 2+ years of case management/utilization review experience
      • 2+ years of Neonatal intensive care and/or Pediatric Intensive care units experience
      • Obstetric experience
      • Experience in a managed care organization -
      • Knowledge of Interqual or Milliman guidelines (MCG) To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm) Nevada Residents Only: The salary range for Nevada residents is $60,000 to $106,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. **PLEASE NOTE** The Sign On Bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or a related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a Sign On Bonus. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, Miami , Pediatric Case Manager RN Registered Nurse - Telecommute in Las Vegas, NV, Healthcare , Miami, Florida

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