RN Case Manager - Telecommute in Albuquerque Metro, 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

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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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

This position facilitates a team approach to ensure cost-effective delivery of quality care and services based on medical conditions and social determinants. Collaborates with members, providers and other resources to evaluate, plan, facilitate and monitor options and services required to meet an individual's healthcare needs. Promotes member's goals for self-management, facilitates effective health care navigation, reduces gaps in care, and provides support and community resources as needed. 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.

If you are located in Albuquerque Metro, NM, you will have the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities:
  • Conducts clinical evaluation of members per regulated timelines, determining who may qualify for case management based on clinical judgment, changes in member's health or psychosocial wellness, and gaps in care
  • Conducts telephonic, clinic, facility, hospital or home visits as indicated for patient evaluation / engagement
  • Identifies barriers to care and seeks solutions with member and the care team
  • Participates in the development and implementation of a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient's needs and goals
  • Performs ongoing updates of the care plan to evaluate effectiveness, and to document interventions and goal achievement
  • Maintains member case load for regular outreach and management, and closes cases per procedure.
  • Uses motivational interviewing to evaluate, educate, support, and motivate change during member contacts
  • Maintains a working knowledge of community resources
  • Achieves productivity and audit standards per department requirements
  • Serves as facilitator and resource for other members of the Medical Group clinical team
  • Attends departmental meetings and provides constructive recommendations for process improvement
  • Performs other duties as assigned

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's Degree in Nursing
  • Valid NM RN License or valid multi-state compact license
  • 21 years or older and valid NM State Driver's license
  • Current BLS Certification
  • 3+ years of job-related experience in a healthcare environment
  • Knowledge of medical terminology
  • Solid computer skills
  • Skilled with MS Office software applications
  • This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease.

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

Physical Requirements and Work Environment:
  • Frequently standing
  • Occasionally sitting
  • Frequently walking
  • Occasionally kneeling/crouching
  • Occasionally lifting Medium to 50 lbs


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

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)

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.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

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 Case Manager, Case Manager, RN, Registered Nurse, BLS, Healthcare, Medical Terminology, MS Office, Albuquerque Metro, Albuquerque, NM, New Mexico, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote

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