Field Care Coordinator - Remote in Ada County, ID and Surrounding Areas

Primary Responsibilities

• Serve as the primary care manager for dual eligible members
• Engage people face-to-face and/or telephonically to complete a comprehensive needs assessment or wellness assessment (as appropriate), including assessment of medical, behavioral, functional, cultural, and social drivers of health (SDoH)
• Develop and implement individualized, person-centered care plans inclusive of goals, opportunities and interventions aligned with a person's readiness to change to support the best health and quality of life outcomes by meeting them where they are in their health journey
• Partner and collaborate with the internal care team, providers, and community resources/partners to implement care plans and remove obstacles so the member can successfully stay in or return to the community (when appropriate)
• Assist members with obtaining necessary HCBS supports and services
• Provide referral and linkage as appropriate and accepted by the individual being served (may include internal consult opportunities such as Housing Navigator, Pharmacy Team, Peer Specialist, etc. or community-based provider referrals such as PCP, specialists, medication assisted therapy referrals, etc.)
• Support proactive discharge planning and manage/coordinate care transition following ER visit, inpatient or Skilled Nursing Facility
• Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
• Advocate for people and families, as needed, to ensure that the member's needs and choices are fully represented and supported by the health care team
• Support Provider and Facility nonclinical questions (credentialing, claims, etc.) connecting them to the correct Health Plan and/or UHC resources

Required Qualifications

• Must meet one of the following:
• - Current and unrestricted Idaho license in one of the below:
• - RN
• - LCSW, LMSW, LSW, LCPC, LPC, LMFT, LAMFT
• - LPN/LVN
• - 2-year degree (or higher) AND 2+ years of experience in Healthcare or Healthcare related industry
• Current and unrestricted Idaho license in one of the below:
• - 1+ years of experience working with people that have Medicaid / Medicare or who have significant social drivers of health (SDoH) needs
• - 1+ years of experience with MS Office, including Word, Excel, and Outlook
• Reliable transportation and the ability to travel within assigned territory to meet with members and providers up to 50% of time depending on member and business needs
• Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)
• Reside in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications

• Certification in Care Management (CCM)
• If individual with 2-year degree and 2+ years of experience, preferably as a Healthcare Paraprofessional
• Experience working with an Electronic Health Record (EHR) system for documentation
• Demonstrated experience / additional training or certifications in care in rural settings homelessness, food insecurity, behavioral health, co-occurring conditions, IDD, Person Centered Care, Motivational Interviewing, Stages of Change, Trauma-Informed Care
• Experience supporting individuals with complex and chronic conditions including those residing in a nursing facility or that meet nursing facility level of care within the community
• Background in Managed Care
• Experience working in team-based care
• Bilingual in Spanish or other language specific to market populations

Physical Requirements

• Ability to transition from office to field locations multiple times per day
• Ability to navigate multiple locations/terrains to visit employees, members and/or providers
• Ability to transport equipment to and from field locations needed for visits (ex. laptop, stethoscope, etc.)
• Ability to remain stationary for long periods of time to complete computer or tablet work duties