RN Case Manager - Hospital Utilization and Transitions of Care

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

We are currently offering a $10,000 sign on bonus for external candidates!

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 erience 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.

Daily operational responsibilities include utilization management, discharge planning, referral facilitation and/or collaboration with hospital‑based case managers/physicians to move patients to appropriate level of care. Provide Care interdisciplinary team communication about the hospital stays. This is an on‑sight hospital‑based function requiring the Case Manager RN to travel to 1‑2 hospitals daily, work in collaboration with the hospitalist to improve outcomes with Observation stay, long discharge plans and prevention of readmission.

Primary responsibility for case management includes discharge planning, improved transitions of care, and utilization management of long length hospitalized health plan members. Ensure members receive quality medical care in the most appropriate setting. Performs the following on a daily basis;
1) performs patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial);
2) develop individualized discharge plans that involve provider, patient and caregiver goals for successful transitions of care;
3) implement discharge plan involving health care resources across the continuum; and
4) monitor and report variances that may challenge timely quality care.

• Assess, plan and implement care strategies that are individualized by patients 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 patient, 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 hospitalized members
• Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
• Utilize approved clinical criteria to assess and determine appropriate level of care for hospitalized members
• Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
• Understand role and how it affects utilization management benchmarks and quality outcomes
• Coordinate hand‑off of care to primary care provider

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.

• High School diploma and/or equivalent
• Active unrestricted Nevada RN license
• Ability to obtain CCM certification within two years of employment
• 2+ years of varied clinical experience in a hospital or clinical setting with an emphasis on case management
• Experience in a managed care organization
• Knowledge of utilization management in a managed care environment
• Independent case management knowledge and skills to formulate plans of care without direct supervision
• Understanding of spectrum of alternative delivery systems
• Ability to use computer‑based programs and applications
• Demonstrated…