Inpatient RN Case Manager - Reno, NV - $1500 Sign On Bonus for External Candidates

UHG Reno, NV

About the Job

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)


As an Inpatient RN Case Manager you will be responsible for the case management and utilization management of hospitalized health plan members including care coordination, improved transitions of care and discharge planning. Ensure patients receive quality medical care in the most appropriate setting. Performs the following case management skills on a daily basis:


What makes your clinical career greater with UnitedHealth Group? You'll work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere. Here, we're working to help others live healthier lives while providing an opportunity for you to do your life's best work.(sm) 

Performs the following case management skills on a daily basis:

  • Perform patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial)
  • Develop individualized discharge plans that involve provider, patient, and caregiver goals for successful transitions of care
  • Implement discharge plan involving health care resources across the continuum
  • Monitor and report variances that may challenge timely quality care 

**Candidates must be flexible to work onsite at a hospital in the Reno, NV area.**


 Primary Responsibilities:

  • 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 and effective discharge planning to prevent readmissions
  • 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 (MCG) to assess and determine appropriate level of care for hospitalized members
  • Utilize approved insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
  • Accountable to understand role and how it affects utilization management benchmarks and quality outcomes
  • Assess, work completed onsite at various acute and alternative level of care facilities within the area

Required Qualifications:

  • Registered Nurse with active unrestricted license in the State of Nevada
  • 2+ years of varied clinical experience in a hospital setting with an emphasis on case management or utilization management
  • Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word and Excel

Preferred Qualifications:

  • Bachelor’s degree
  • CCM certification or ability to obtain within 2 years of employment

  • Case management/utilization review experience preferred
  • Knowledge of MCG  guidelines
  • Experience in a managed care organization

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)



Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.


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



Job Keywords:  RN, Nurse, Case Manager, Case Management, Utilization Management, Utilization Review, Claims, MCG, Milliman, Appeals, Grievances,  CCM, Medicaid, Public Health,  Care Coordination, Prior Authorization, Discharge Planning, Medical Adjudication, Managed Care, Reno, NV, Nevada, UHG, UnitedHealth Group, UHC, UnitedHealthcare