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OnsiteTelephone RN Case Manager - Las Vegas, NV

UnitedHealth Group

Las Vegas, NV
Job Code:
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Job Details

738280 OnsiteTelephone RN Case Manager Las Vegas NV

OnsiteTelephone RN Case Manager - Las Vegas, NV (738280)

Position Description

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 Case Manager, you'll be making a difference in peoples' lives by offering support and assistance to members seeking health education, program referrals or general health services. You will work with patients to manage their health conditions as dictated by consumer and business needs.


As the RN Case Manager you are responsible for the management and coordination of Case Management services for members hospitalized in acute / subacute settings. As the Case manager you will work directly with the member, providers(s), and facility to ensure the most appropriate care is provided. The Case Manager will assess, plan, implement, coordinate, monitor, and evaluate 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 Milliman criteria to determine if patients are in the correct hospital setting
  • Coordination of member's care through the health care continuum
  • Collaborate with member, provider, facility to obtain best outcome
  • Utilize both company and community based resources to establish a safe and effective case management plan for hospitalized members
  • Complete cost-benefit analysis as appropriate
  • Identifying gaps or barriers in treatment plans
  • Review cases with Medical Directors daily on challenging cases as needed
  • Making referrals to outside sources
  • Documenting and tracking findings

Required Qualifications: 

  • Current, unrestricted NV RN license or temporary NV RN license with the ability to obtain permanent NV RN license upon expiration of temporary NV RN license
  • 3 + of Clinical RN experience
  • 3+ years of experience using Electronic Medical Records (EMR)
  • 1 year of Utilization Management experience

Preferred Qualifications:  

  • Bachelor's degree in Nursing
  • Managed care experience
  • Certification in Case Management (CCM) or equivalent Professional Certification (ACM)
  • Knowledge of Interqual or Milliman guidelines

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


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.



Job Keywords: RN, Registered Nurse, Case Manager, CCM, UM Review, case management, utilization review, LV, Las Vegas, Nevada, NV , Mountains Edge Hospital, Millimam

Job Details

  • Contest Number738280
  • Job TitleOnsiteTelephone RN Case Manager - Las Vegas, NV
  • Job FamilyNursing
  • Business SegmentOptumCare

Job Location Information

  • Las Vegas, NV
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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