Clinic Case Manager
Company: Optum
Location: Bernalillo
Posted on: May 24, 2025
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Job Description:
Optum NM is seeking a Clinic Case Manager to join our team in
Albuquerque, NM. Optum is a clinician-led care organization that is
changing the way clinicians work and live.
As a member of the Optum Care Delivery team, you'll be an integral
part of our vision to make healthcare better for everyone.
At Optum, you'll have the clinical resources, data and support of a
global organization behind you so you can help your patients live
healthier lives. Here, you'll work alongside talented peers in a
collaborative environment that is guided by diversity and inclusion
while driving towards the Quadruple Aim. We believe you deserve an
exceptional career, and will empower you to live your best life at
work and at home. Experience the fulfillment of advancing the
health of your community with the excitement of contributing new
practice ideas and initiatives that could help improve care for
millions of patients across the country. Because together, we have
the power to make health care better for everyone. Join us and
discover how rewarding medicine can be while Caring. Connecting.
Growing together.
The Clinic 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
delegated nursing duties within the scope of a RN license of the
applicable state board of nursing.
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Position in this function 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.
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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
3+ years of job-related experience in a healthcare environment
Knowledge of medical terminology
Proven skilled with MS Office software applications
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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
Proven excellent communication, interpersonal, organization and
customer service skills
Proven self-motivated, solid computer skills
Proven attention to detail
Proven ability to multi-task and work under pressure
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The salary range for this role is $59,500 to $116,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. In addition to your salary,
UnitedHealth Group offers benefits such as, a comprehensive
benefits package, incentive and recognition programs, equity stock
purchase and 401k contribution (all benefits are subject to
eligibility requirements). No matter where or when you begin a
career with UnitedHealth Group, you'll find a far-reaching choice
of benefits and incentives.
OptumCare is an Equal Employment Opportunity employer under
applicable law and qualified applicants will receive consideration
for employment without regard to race, national origin, religion,
age, color, sex, sexual orientation, gender identity, disability,
or protected veteran status, or any other characteristic protected
by local, state, or federal laws, rules, or regulations.
OptumCare is a drug-free workplace. Candidates are required to pass
a drug test before beginning employment.
Keywords: Optum, Rio Rancho , Clinic Case Manager, Healthcare , Bernalillo, New Mexico
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