Hospital Care Manager, RN

Position Overview

UNITE HERE HEALTH serves over 200,000 workers and their families in the hospitality and gaming industry nationwide. Our innovative and progressive approach drives the development of impactful programs and benefits that engage participants in managing their own health and healthcare.

This is a Nevada Health Solutions (Culinary Health Fund) position. The Medical Management department is participant focused and strives to provide high-quality, cost-efficient healthcare through Utilization Review, Care Coordination, and Outreach. The Hospital Care Manager ensures that participants receive the best quality care in the appropriate setting by assessing, planning, coordinating, and monitoring care across the continuum – from acute hospital settings to lower levels of care.

Key Responsibilities

• Provide Utilization Review within URAC timelines and expectations.
• Work with participants of all ages in acute hospital and lower level care settings (LTAC, SNF, Rehab) to guide them through the continuum of care.
• Maintain continuous communication with all parties involved in the plan of care to determine medical necessity and appropriateness of services.
• Follow all hospital policies and procedures.
• Drive daily within the Las Vegas Metropolitan area based upon assignment using a Fund-owned, leased, or personal vehicle (with proper registration and insurance).
• Redirect care to contracted service providers per guidelines.
• Communicate daily with attending physicians regarding treatment and discharge planning needs.
• Participate in weekly Medical Rounds with the Medical Director and team.
• Provide necessary interventions to ensure effective and efficient discharge planning.
• Research patient issues, barriers to care and report findings to management.
• Coordinate and attend family conferences for challenging discharge planning (e.g., hospice, long term care, non-compliance).
• Coordinate hospital-to-hospital transfers in conjunction with hospital staff.
• Maintain comprehensive, accurate, and up-to-date records of patient care.
• Identify delays in care and forward cases to physician reviewers for medical necessity review.
• Flag quality issues and refer them to the Quality Committee for review.
• Assist management in development of protocols and procedures pertaining to UM/CM.
• Support onboarding and training of new staff.
• Participate in the weekend on-call rotation.
• Conduct benefit education for participants and providers.

Required Qualifications

• Minimum 3 years’ experience in a hospital environment or equivalent required.
• Associate's degree in Nursing required.
• Valid, unrestricted state driver’s license.
• Personal vehicle registration and insurance.
• Unrestricted active RN License in the State of Nevada.
• Willingness and ability to obtain a license in other states as required by the Fund.

Preferred Qualifications

• Preferred fluency in Spanish (speak and write).
• Experience with Case Management and Managed Care.
• Bachelor’s degree in Nursing preferred.
• CCM certification preferred.

Compensation: Salary range for this position is $93,900 - $117,300. Actual base salary may vary based on relevant experience, qualifications, certifications, licenses, education, performance, and geographic location.

Work Schedule: Monday–Friday, 7.5 hours per day (37.5 hours per week) with a remote opportunity and daily in-person visits to local hospitals.

Benefits & Perks

• Medical
• Dental
• Vision
• Paid Time-Off (PTO)
• Paid Holidays
• 401(k)
• Short- & Long-term Disability
• Life, Pension, AD&D
• Flexible Spending Accounts (Healthcare & Dependent Care)
• Commuter Transit
• Tuition Assistance
• Employee Assistance Program (EAP)