Clinical Case Manager - Telecommute

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

• 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