Medical Behavioral Integration RN Case Manager - Albuquerque, NM
Location: Albuquerque, New Mexico
Internal Number: 120203062
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's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
Compassion is the essential trait that drives superior health care performance. But it's just a start. At OptumCare innovative thinking is just as important. Our unique team of health care providers are an emerging and important part of Optum and the UnitedHealth Group family of businesses. Our approach is designed to help physicians and other providers deliver the right care at the right time in the right setting. That takes smart ideas and incredible teamwork. And that's where you come in. In this role, you'll support a clinical team that's helping patients in new and better ways while giving them a generous helping of compassion and respect.
This position integrates a collaborative process which plans, implements, coordinates, monitors and evaluates options and services to meet the member’s behavioral health needs, using education, communication and all available resources to promote quality, cost-effective outcomes.
***This is a full time, Monday-Friday position. The RN must be able to travel within assigned territory / location area to conduct critical face to face assessments. Territory Assignments are based on business needs. Applicants must be willing to carry a diverse clinical caseload and visit the patient in their home, hospital, SNF,etc.***
Screens and identifies members with high-risk, long term chronic conditions who will benefit from care management services. Monitors utilization as needed. Referrals for cases may originate from various sources
Performs member evaluations and onsite visits as needed in multiple settings, including but not limited to: telephonic, member's homes, PCP/Specialists clinic, hospital, and skilled nursing facilities and provides feedback on planned interventions and outcomes of the plan of care
Performs comprehensive assessments, identifies and assists members with high-risk symptoms/diagnoses and/or members with multiple co-morbidities who will benefit from intervention and engaging in care management services, information is collected from the patient, caregiver(s), health care providers and other relevant parties as needed
Documents findings and develops individualized careplans in a concise/comprehensive manner compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
Utilizes advanced clinical skills to make effective decisions to meet the member’s health, behavioral health and psychosocial needs, providing coaching, patient education, communication, and all available resources to promote quality and cost-effective outcomes
Documents patient/family status, diagnosis, medications, treatment plan, goals, interventions, evaluation results, observations and progress in electronic medical record/proprietary database in a timely and accurate manner
Advocates for members and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team
Integrates a collaborative approach by attending interdisciplinary team meetings with nurses, physicians and patient care coordinators regarding patient care as needed; Collaborates with providers to determine acuity of behavioral health concerns and refer members to appropriate community resources
Utilizes professional knowledge and critical thinking skills to facilitate MD consultation on complex and/or complicated cases
Applies Nursing/Counseling/Social Work theory, knowledge, professional ethics, methods, and interventions to improve member health and psychosocial functioning within the scope of licensure and job function
Manages assigned case load in an efficient and effective manner
Performs all other related 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.
Current, unrestricted RN license in the state of NM
2+ years of clinical experience in an acute care, home health, hospice, geriatric, behavioral health and / or hospital setting
Experience using EMR and CM practice guidelines
Knowledge of discharge planning alternatives options and interdisciplinary approaches
Able to handle sensitive issues with members and providers in a confidential manner according to HIPAA guidelines
Access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area (up to 75% of the time in the field)
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
OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, 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 the health system 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.