Clinic Case Manager

Optum NM is seeking a Clinic Case Manager to join our team in Albuquerque, NM, located at 9101 Montgomery Blvd. NE. Optum is a clinician-led care organization that is changing the way clinicians work and live. As part of the Optum Care Delivery team, you'll help advance our vision to make healthcare better for everyone. You'll work alongside talented peers in a collaborative, inclusive environment while driving toward the Quadruple Aim. We empower you to live your best life at work and at home, offering the fulfillment of improving community health and the excitement of contributing new practice ideas that could enhance care for millions.

About the role

The Clinic Case Manager fosters collaboration and a team approach to support patients with high-risk health conditions, helping them navigate the healthcare system. This role acts as an educator, resource, and advocate for patients and their families to ensure a high quality of life. You will collaborate with multidisciplinary care teams, including physicians, nurses, pharmacists, case managers, social workers, and other educators, while serving as a clinic resource for the value-based population. The position operates in a less structured, self-directed environment and performs nursing duties within the scope of an RN license, ensuring compliance with contractual and service standards set by relevant health insurance plans.

Responsibilities

• Embedded within the primary care clinic, working directly with patients, clinical, and non-clinical teams
• Participates in identifying a focused clinic patient panel, as defined by the manager of Medical Management
• Supports longitudinal care of patients with chronic conditions:
  • Communicates with patients, responding to questions via patient portal and other modalities
  • Performs assessments of health conditions and implements care plans in collaboration with patients, caregivers, clinicians, and other healthcare professionals
  • Pursues interventions to reduce risks of condition exacerbation, ER visits, and hospitalizations
  • Performs medication reconciliation and collaborates with clinician partners 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 plans
  • Provides patient education
  • Assists with post-discharge needs such as home health care, prescriptions, transportation, Durable Medical Equipment (DME), and appointments
  • Coordinates with providers to establish or update individualized plans 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 scope of practice
• Participates in daily huddles and monthly clinic meetings, as required
• Prepares accurate and timely reports
• Maintains continued competence in nursing practice and knowledge of current evidence-based practices
• Performs ongoing updates of the care plan to evaluate effectiveness and document interventions and goal achievement
• Maintains a working knowledge of community resources
• Serves as a 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

Requirements

• 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
• Proven knowledge of medical terminology
• Proficient with MS Office software applications

Qualifications

• Bachelor's degree or higher in a healthcare-related field (preferred)
• 2+ years of experience providing prior authorization or case management within a health plan or integrated system (preferred)
• Excellent communication, interpersonal, organization, and customer service skills (preferred)
• Self-motivated with solid computer skills (preferred)
• Strong attention to detail (preferred)
• Ability to multi-task and work under pressure (preferred)

Pay

The salary for this role ranges from $60,200 to $107,400 annually based on full-time employment. Pay is determined by several factors, including local labor markets, education, work experience, and certifications.

Benefits

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).