Pediatric RN Case Manager - Las Vegas, NV

UHG Las Vegas, 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 the RN Case Manager you will be responsible for discharge planning, improved transitions of care, and utilization management of hospitalized high risk OB patients and pediatric members. The RN Case Manage will ensure they receive quality medical care in the most appropriate setting. You will perform the following case management skills on a daily basis: 1) perform 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.


Candidates must be available to work Monday - Friday 8:00 am - 5:00 pm from our office located at 2716 N Tenaya in Las Vegas, NV.


Primary Responsibilities:

  • Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease 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
  • Accountable to understand role and how it affects utilization management benchmarks and quality outcomes

Required Qualifications:

  • Current, unrestricted license RN license in the State of Nevada
  • 3+ years of clinical experience
  • High risk OB and/or pediatric experience
  • Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word  and Excel

Preferred Qualifications:

  • Bachelor’s degree

  • Certification in Case Management (CCM) or ability to obtain CCM within 2 years of employment

  • Previous case management experience

  • Managed care experience

  • Knowledge of InterQual or Milliman guidelines

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:  Registered Nurse, RN, Nurse, Case Manager, Adult CCM, High Risk, Pediatric, OB, Obstetrics,  CCM, Medicaid , Public Health,  Care Coordination, Case Management, Disease Management, NCQA, CMS, Utilization Review, Prior Authorization, Discharge Planning, Managed Care, Las Vegas, NV, Nevada, UHG, UnitedHealth Group, UHC, UnitedHealthcare