6 Senior Complex Case Manager Jobs in Albuquerque, NM
UnitedHealth Group is Hiring a Senior Complex Case Manager Near Albuquerque, NM
- Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member's health, social determinants, and gaps in care
- Creates and implements a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient’s needs and goals
- Performs ongoing updates of the care plan to evaluate effectiveness, and to document barriers, interventions, and goal achievement
- Partners with primary providers or multidisciplinary team members to align or integrate goals to plan of care
- Completes home, facility, clinic and telephonic visits for member engagement and enrollment
- Uses motivational interviewing to evaluate, educate, support, and motivate change during member contacts
- Identifies and considers appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed
- Ensures compliance with quality metrics specific to health plan delegation and accrediting body requirements
- Conducts self and peer audits on a regular and assigned timeline
- Maintains caseload per defined medical management department standards
- Sustains productivity and audit requirements per medical management department standards
- Demonstrates ability to work independently and implement innovative approaches to complex member situations
- Sought out as expert and serves as leader/mentor/preceptor to other members of medical management team.
- Determines need for continued member management, creates care plan and facilitates transition to medical management programs
- 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
- Associates Degree in Nursing
- Valid New Mexico RN License or valid multi-state compact license
- Current BLS Certification
- 3 years of previous job-related experience in a healthcare environment
- Experience utilizing excellent communication, interpersonal, organization and customer service skills
- Demonstrated ability to multi-task and work under pressure
- Demonstrated knowledge of computer functionality and software applications (e.g., navigating systems, troubleshooting, electronic charting, accessing intranet and record management databases)
- Demonstrated knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, commercial) or regulatory bodies (e.g., NCQA)
- Demonstrated understanding of relevant health care benefit plans
- 21 years or older and hold a valid New Mexico State Driver’s license
- 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
Job Summary
Full Time
Insurance
$84k-101k (estimate)
05/20/2023
07/16/2024
unitedhealthgroup.com
THREE BRIDGES, NJ
>50,000
1980
Insurance
Related Companies
About UnitedHealth Group
Our mission is to help people live healthier lives and to help make the health system work better for everyone. A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, were doing a lot of good for more than 142 million people worldwide. Our biggest point of differentiation is our people - and the collective ta...lent, energy, intelligence and drive our force of 305,000 individuals around the world bring to our mission every single day. So, how do we do it? With our every action, interaction and intention that demonstrates the five fundamental values that guide everything we do: Integrity Compassion Relationships Innovation Performance If you're looking for a place where your drive, compassion and passion can make a difference in the health and well-being of others, consider UnitedHealth Group. Click below to search careers or join our social communities: Search and apply for careers at: http://careers.unitedhealthgroup.com Like us on Facebook at: http://www.facebook.com/uhgcareers Follow us on Twitter at: http://www.twitter.com/uhgcareers Diversity creates a healthier atmosphere: 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.
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