Clinical Case Manager - TelecommuteUnitedHealth Group • Albuquerque, NM, United States

Clinical Case Manager - Telecommute

UnitedHealth Group • Albuquerque, NM, United States

30+ days ago

Job type

Full-time

Job description

Primary Responsibilities :

Role embedded within the primary care clinic, working directly with patients, clinical and non-clinical teams
Participates in the identification of a focused clinic patient panel, as defined by the manager of Medical 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 Emergency Department or inpatient stay 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 home health care, prescriptions, transportation, Durable Medical Equipment (DME), appointments

Coordinates with providers to establish or update individualized plan of care

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

Performs triage and clinical tasks within their scope of practice

Participates in daily huddles and monthly clinic 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

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 degree in nursing

Valid NM RN License or valid multi-state compact license

Current BLS Certification

Must be 21 years or older and have a valid NM State Driver's license

3+ years of previous job-related experience in a healthcare environment

Knowledge of medical terminology

Skilled with MS Office software applications

Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

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Clinical Case Manager • Albuquerque, NM, United States

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