RN Care Manager-Clinic - Albuquerque, NM

Careers at UnitedHealth Group

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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.

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:
  • Associates Degree in Nursing
  • Valid NM RN License or valid multi-state compact license
  • Current BLS Certification
  • 21 years or older and have a valid NM State Driver's license
  • 3+ years of job-related experience in a healthcare environment

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

Physical Demands:

Rarely (Less than .5 hours/day) Light to 10 lbs
Occasionally (0.6 - 2.5 hours/day) Medium to 50 lbs
Frequently (2.6 - 5.5 hours/day) Heavy 50 lbs to 100lbs
Continuously (5.6 - 8.0 hours/day)
  • Standing
  • Sitting
  • Walking
  • Kneeling/Crouching
  • Lifting

To protect the health and safety of our workforce, patients, and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state, and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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: Nurse Case Manager, RN, Nurse, Registered Nurse, healthcare environment, medical terminology, Albuquerque, New Mexico, NM

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