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, youll be an integral part of our vision to make healthcare better for everyone.

At Optum, youll 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.
Position in this function is responsible for the outpatient care management and coordination of high-risk high need patients empanelled to and IPA or Network PCP, for Medicare Advantage population. Works with the Members, Members families, the PCPs, Medical Offices, Specialty offices to ensure optimal outpatient outcomes. Follows the standards of Case Management and acts as the single point of contact for patients, families, and providers. Maintains records and data analysis related to high risk cases to report outcomes and ROI. Works collaboratively with all internal and external partners to ensure best clinical outcomes.
Primary Responsibilities:
Apply case management standards of practice to focus on effective care of high risk high need patients empanelled to non-SMA PCPs
Serve as a patient advocate and resource and provide critical information and recommendations to the rest of the care team
Participates in assessment activities to develop individualized plans of care in coordination with patient, family and providers
Follows patient through various transitions of care to ensure that any gaps are identified and remedied, break down silos and promote efficient health care delivery. Works together with Medical Director to determine effective plans of care in the prevention of readmissions to acute care
Maintains strong knowledge of UM, Case management, community resources and plan benefits to ensure improved outcomes
Works collaboratively with primary care to ensure patient compliance and adherence to medical plan of care
Assist clinicians in implementing best practices for chronic care and disease management
Follow standard protocols, processes and policies to include but not limited to the following: Medication Refill, Preventative Services, Managing Conditions, and Disease Case Management as signed by department head or designee
Youll 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
Registered Nurse with active unrestricted license in the State of Nevada
3+ years of direct patient care nursing with a focus on discharge planning or case management
Knowledge of UM and plan benefit designs
Solid clinical knowledge and capacity for continued learning
Proficient in critical thinking skills of RN Case manager
Demonstrated ability to perform case management activities
Proven solid verbal and written communication skills
Proven competent with MS Office and other practice management systems or possess the ability to continue to learn new things
Proven ability to organize and prioritize tasks for self and patients
Must possess a valid Nevada drivers license and maintain personal auto insurance coverage
Preferred Qualifications:
Bachelors degree in healthcare or related field or working towards completion of Bachelors degree
CCM certification
WORKING CONDITIONS
Normal office or hospital environment
Ability to have their own transportation to travel frequently within the Las Vegas Valley
Ability to pass FIT testing and wear protective mask as deemed by SMA in the course of work at clinic
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). No matter where or when you begin a career with us, youll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.63 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.