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Telephone Triage RN Case Manager – 10K Sign On Bonus for External Candidates
2361226 $10,000 Sign-on Bonus for External Candidates 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 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
- 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
- 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
