RN Case Manager- CLINIC LOCATION - 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

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)

The RN CLINICAL CASE MANAGER is responsible for fostering collaboration and a team approach for successfully supporting patients with high risk health conditions to navigate the healthcare system. Promotes empowerment by facilitating the role of an educator, resource, and advocate for patients and their families to ensure a maximum quality of life. Interacts and collaborates with multidisciplinary care teams, to include physicians, nurses, pharmacists, case managers, social workers, and other educators. Acts as a clinic resource for the value-based population. Works in a less structured, self-directed environment and performs all nursing duties within the scope of a RN license of the applicable state board of nursing.

This role ensures compliance to contractual and service standards as identified by relevant health insurance plans. Adheres to policies, procedures, and regulations to ensure compliance and patient safety. Participation in Compliance and required training is a condition of employment.

Primary Responsibilities:
  • Role embedded within the primary care clinic, working directly with both clinical and non-clinical staff
  • Participates in the identification of a focused clinic patient panel, as defined by the manager of Case/Disease management
  • Supports longitudinal care of the patient with chronic care conditions:
    • Communicates with patients, responding to patient questions via patient portal and other modalities
    • Performs assessment of health conditions and implements care plan in collaboration with the member, caregiver(s), clinician(s), and/or other appropriate healthcare professionals to address need and goals
    • Pursues appropriate interventions to reduce risk of condition exacerbation, ER and hospitalization utilization
    • Performs medication reconciliation and collaborates with clinician partner as needed
    • Conducts Motivational Interviewing and Self-Management Goal setting
    • Provides patient education
    • Creates referrals to appropriate agencies and resources
  • Supports transition of care from inpatient to outpatient setting:
    • Performs assessment of transitional needs
    • Performs medication reconciliation
    • Establishes and reviews contingency plan
    • Provides patient education
    • Assists with post discharge needs such as prescriptions, transportation, Durable Medical Equipment (DME), appointments
  • Coordinate with providers to establish or update individualized plan of care
  • Operates in the clinical role through support of standing orders or Care Paths
  • Creates referrals to appropriate internal and external resources
  • Achieves Quality Measures outcomes via reduction in HEDIS Gaps in Care
  • Performs accurate and timely documentation in the electronic medical record
  • May perform clinical tasks within their scope of practice
  • Participates in daily huddles and Patient Care Coordination (PCC) meetings, as required
  • Prepares accurate and timely reports, as required
  • Maintains continued competence in nursing practice and knowledge of current evidence-based practices
  • Performs ongoing updates of the care plan to evaluate effectiveness, and to document interventions and goal achievement
  • Maintains a working knowledge of community resources
  • Serves as facilitator and resource for other members of the Medical Group clinical team
  • Attends departmental meetings and provides constructive recommendations for process improvement

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:
  • Associate degree in nursing
  • Valid NM RN License or valid multi-state compact license
  • Current BLS Certification
  • 3+ years of job-related experience in a healthcare environment
  • Knowledge of medical terminology
  • Skilled with MS Office software applications
  • 21 years or older and have a valid NM State Driver's license

Preferred Qualifications:
  • Bachelor's degree or higher in healthcare related field
  • 2+ years of experience providing prior authorization or case management within health plan or integrated system
  • Excellent communication, interpersonal, organization and customer service skills
  • Self-motivated, strong computer skills
  • Attention to detail
  • Ability to multi-task and work under pressure


Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do 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 Clinical Case Manager, Albuquerque, NM, New Mexico

Advertisement

937458