RN Case Manager, Clinic Location - Albuquerque, NM

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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
  • 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:
  • 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

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.

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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