RN Case Manager - Hospital Utilization and Transitions of Care

Responsibilities

• Assess, plan, and implement individualized care strategies to ensure patients are directed to the most appropriate and least restrictive level of care.
• Perform patient assessments across all major domains, including physical, functional, financial, and psychosocial factors.
• Develop and implement individualized discharge plans involving providers, patients, and caregivers to ensure successful transitions of care.
• Collaborate with hospitalists, physicians, and interdisciplinary teams to improve outcomes for observation stays and prevent readmissions.
• Utilize approved clinical criteria and company resources to manage utilization and coordinate care hand-offs to primary care providers.
• Advocate for patients and families to ensure their needs and choices are supported by the healthcare team.
• Monitor and report variances that may challenge timely, quality care delivery.

Requirements

• High School diploma or equivalent.
• Active, unrestricted Nevada RN license.
• 2+ years of clinical experience in a hospital or clinical setting, with an emphasis on case management.
• Experience working within a managed care organization.
• Valid Nevada driver's license and ability to maintain personal auto insurance.
• Ability to obtain CCM certification within two years of employment.
• Proficiency in using computer-based programs and applications.

Preferred Qualifications

• Bachelor's degree in nursing or a related field.
• Knowledge of Interqual or Milliman guidelines.
• Recent experience in Emergency Room care or hospital discharge planning.

Benefits

• Comprehensive health plans and coverage to support physical wellness.
• Financial benefits including retirement planning and 401k contributions.
• Emotional support resources and tools to build resilience and manage stress.
• Incentive and recognition programs.

About the Company

Optum is a clinician-led care organization dedicated to changing the way clinicians work and live. We provide the clinical resources, data, and support of a global organization to help patients live healthier lives and empower our team members to achieve professional and personal fulfillment.