[15h Left] Clinic Case Manager
Company: Optum
Location: Albuquerque
Posted on: July 3, 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. 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. 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 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 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, Albuquerque , [15h Left] Clinic Case Manager, Healthcare , Albuquerque, New Mexico