Job Description

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
* Current BLS Certification
* 3+ years of job-related experience in a healthcare environment
* Knowledge of medical terminology
* Self-motivated, strong computer skills
* Skilled with MS Office software applications
* 21 years or older and valid NM State Driver's license
* You will be provisioned with appropriate Personal Protective Equipment (PPE) and are required to perform this role with patients and members on site, as this is an essential function of this role
* Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

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

Physical Requirements and Work Environment:

* Frequently standing
* Occasionally sitting
* Frequently walking
* Occasionally kneeling/crouching
* Occasionally lifting Medium to 50 lbs

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)

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

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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. Optum is a drug-free workplace. (C) 2021 Optum. All rights reserved.

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