RN Complex Case Management - Hybrid in Las Vegas, NV

RN Complex Case Management

Optum NV is seeking a RN Complex Case Management to join our team in Las Vegas, NV. Optum is a clinician-led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

This role is responsible for outpatient care management and coordination of Medicare Advantage patients empaneled to IPA or Network PCPs. The RN Case Manager serves as a single point of contact for patients, families, and providers, ensuring seamless care across the continuum.

This position requires solid critical thinking skills, the ability to manage a high-volume caseload (70+ patients), and a proactive approach to hospital follow-ups, patient education, and care coordination to improve outcomes and reduce readmissions.

The RN Case Manager collaborates with patients, families, PCPs, specialists, and interdisciplinary teams to promote optimal outpatient outcomes, close gaps in care, and ensure adherence to care plans.

If you are located in Las Vegas, NV, you will follow a hybrid schedule with three in-office days per week.

Primary Responsibilities:

• Manage a caseload of 70+ patients, prioritizing care needs using solid clinical judgment and critical thinking
• Perform post-hospital discharge follow-ups to ensure safe transitions of care and reduce avoidable readmissions
• Provide patient education on diagnoses, medications, and treatment plans to improve self-management and adherence
• Coordinate care across primary care, specialty providers, and community resources to ensure continuity and quality outcomes
• Apply case management standards of practice to effectively manage MA populations
• Serve as a patient advocate, providing clinical insight and recommendations to the interdisciplinary care team
• Conduct assessments and develop in collaboration with patients, families, and providers
• Identify and close gaps in care across transitions, breaking down silos and promoting efficient healthcare delivery
• Partner with providers to implement strategies that prevent readmissions and improve outcomes
• Maintain solid knowledge of case management practices, benefits, and community resources
• Support chronic disease management and preventative care initiatives with accurate documentation
• Follow established protocols related to medication management, preventive services, and disease management

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:

• High School diploma or equivalent
• Active, unrestricted Registered Nurse (RN) license in the State of Nevada
• 3+ years of direct patient care nursing experience, including discharge planning or care coordination
• 2+ years of dedicated Case Management experience
• Demonstrated solid critical thinking and clinical decision-making skills in a case management setting
• Proven experience managing complex, high-risk patient populations and high-volume caseloads
• Proven knowledge of utilization management and health plan benefit structures
• Proven excellent verbal and written communication skills
• Proven solid organizational, prioritization, and care coordination skills
• Proficiency with MS Office and care management systems
• Valid Nevada driver's license with access to reliable transportation and active auto insurance

Preferred Qualifications:

• Bachelor's degree in Nursing or related healthcare field (or in progress)
• Certified Case Manager (CCM) certification

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $29.00 to $54.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

OptumCare 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.

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