Licensed Field Care Coordinator - Middle TN

About the role

The primary purpose of this position is the application of clinical knowledge to coordinate member care needs for assigned members who are primarily medically complex and require intensive medical and psychosocial support. The Care Coordinator works directly with members to ensure appropriate access to services and providers. Coordination of member care needs across the continuum begins with early identification of health risk factors, education, and prevention using the six essential activities of case management as per CMSA. Coordination also assures the provision of appropriate services in acute, home, chronic and alternative care settings, to meet member needs in the most cost-effective manner available. Collaborates with all members of the Care Coordination team including Case Management, Utilization Review and Behavioral Health team members.

Responsibilities

• Incorporates evidence-based clinical practices into care coordination activities
• Delivers member-centered, individualized self-management support and patient education
• Installs appropriate equipment or supplies as needed and educates member on safe and effective use
• Facilitates and participates in group visit strategies as defined by site, member and/or provider needs
• Ensure appropriate utilization and consistent application of the health benefits
• Conduct telephonic and face to face assessments according to Health Plan policy and procedure, including CommunityCare System documentation and State prescribed timeframes
• Serve as member advocate and facilitator to resolve issues that may be perceived as barriers to care
• Provide education and coordination of community resource referrals to members and providers
• Develop, implement, maintain and evaluate a member centered, individual care plan when services are indicated, based on member care needs identified through proactive collaboration and communication with members, families and providers
• Collaborate and communicate with other members of the Care Coordination Team to improve the quality and efficiency of health care delivery and assure smooth transition of care coordination activities to other team members
• Coordinates care with UnitedHealthcare Inpatient Care Manager when member becomes hospitalized or seeks Emergency Room Services
• Maintain time sensitive documentation to assure compliance with regulatory agencies
• Coordinate services for members following Health plan policy
• Perform other duties as assigned

Qualifications

• Current nursing license (RN) OR Licensed Social Worker
• 2+ years of clinical experience as an RN or Social Worker
• 1+ years of experience with MS Office, including Word, Excel, and Outlook
• Excellent organization, communication and time management skills
• Valid driver's license, access to reliable transportation and the ability to travel up to 75% within an assigned territory to meet with members and providers
• Reside in or within a 50 mile radius commutable driving distance to Coffee, Franklin, Van Buren, Warren or Grundy Counties

Preferred Qualifications

• BSN, Master's Degree or Higher in Clinical Field
• CMM certification
• 1+ years of community case management experience coordinating care for individuals with complex needs
• Long term care experience
• Experience working in team-based care
• Working knowledge of Medicare/Medicaid regulations
• Working knowledge of medical terminology

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

Pay

Hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Equal Opportunity Employer

We are committed to providing equal employment opportunities for all applicants and employees. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other characteristic protected by law.

Environmental Stewardship

UnitedHealth Group is dedicated to reducing its environmental impact and enabling and delivering equitable care that addresses health disparities and improves health outcomes.