RN Case Manager, Telephonic - Hybrid - Las Vegas, | 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. 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, Member's 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 PCP's
• 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

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
• 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 driver's license and maintain personal auto insurance coverage

Preferred Qualifications:

• Bachelor's degree in healthcare or related field or working towards completion of Bachelor's 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). 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.