Medical Behavioral RN Case Manager - Albuquerque, NM

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Optum is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The Optumcare Medical Behavioral Integration Nurse Case Manager (MBI NCM) is a direct clinical liaison between OptumCare/Care Delivery organization customers and the clinical network. This position integrates a collaborative process which assesses plans, implements, coordinates, monitors and evaluates options and services to meet the member's health needs, using education, communication and all available resources to promote quality, cost-effective outcomes.

Primary Responsibilities:
  • Screens and identifies members with high-risk, long term chronic conditions who will benefit from care management services. Monitors utilization as needed. Referrals for cases may originate from various sources
  • Performs member evaluations and onsite visits as needed in multiple settings, including but not limited to: telephonic, member's homes, PCP/Specialists clinic, hospital, and skilled nursing facilities and provides feedback on planned interventions and outcomes of the plan of care
  • Performs comprehensive assessments, identifies and assists members with high-risk symptoms/diagnoses and/or members with multiple co-morbidities who will benefit from intervention and engaging in care management services, information is collected from the patient, caregiver(s), health care providers and other relevant parties as needed
  • Documents findings and develops individualized careplans in a concise/comprehensive manner compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
  • Utilizes advanced clinical skills to make effective decisions to meet the member's health, behavioral health and psychosocial needs, providing coaching, patient education, communication, and all available resources to promote quality and cost-effective outcomes
  • Documents patient/family status, diagnosis, medications, treatment plan, goals, interventions, evaluation results, observations and progress in electronic medical record/proprietary database in a timely and accurate manner
  • Advocates for members and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
  • Integrates a collaborative approach by attending interdisciplinary team meetings with nurses, physicians and patient care coordinators regarding patient care as needed; Collaborates with providers to determine acuity of behavioral health concerns and refer members to appropriate community resources
  • Utilizes professional knowledge and critical thinking skills to facilitate MD consultation on complex and/or complicated cases
  • Applies Nursing/Counseling/Social Work theory, knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function
  • Manages assigned case load in an efficient and effective manner


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.

Required Qualifications:
  • Active and unrestricted licenses
  • RN with 2+ years of experience
  • 2+ years experience in a related field-based case management
  • Proficient computer skills and good working knowledge of Microsoft Word
  • Maintain direct and open communication with all levels of the organization
  • Able to handle sensitive issues with members and providers in a confidential manner according to HIPAA guidelines
  • Demonstrates initiative in achieving individual, team, and organizational goals and objectives
  • Ability and flexibility to assume responsibilities and tasks in a constantly changing work environment
  • Ability to travel locally up to 75% of the time for patient home visits
  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance


Preferred Qualifications:
  • Medical/Behavioral setting experience (i.e. hospital, managed care organization, or joint medical/behavioral outpatient practice)
  • Dual diagnosis experience with mental health and substance abuse
  • Experience working in an environment that required coordination of benefits and utilization of multiple groups and resources for patients
  • Experience working with low-income populations
  • Experience working with the aged, blind or disabled
  • Clinical training experience
  • Excellent customer service skills
  • Excellent interpersonal and problem-solving skills
  • Solid team player and team building skills
  • Able to function independently and responsibly with minimal supervision
  • Solid oral and written communication skills, specifically telephone skills


UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Careers at OptumCare. We're on a mission to change the face of health care. As the largest health and wellness business in the US, we help 58 million people navigate the health care system, finance their health care needs and achieve their health and well-being goals. Fortunately, we have a team of the best and brightest minds on the planet to make it happen. Together we're creating the most innovative ideas and comprehensive strategies to help heal the health care system and create a brighter future for us all. Join us and learn why there is no better place to do your life's best work.(sm)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: RN, NURSE, Behavioral Health Nurse, Albuquerque, NM, New Mexico

Advertisement

2015630