Licensed Field Care Coordinator - Middle TN

Primary 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
• Ensures appropriate utilization and consistent application of the health benefits
• Conducts telephonic and face to face assessments according to Health Plan policy and procedure, including CommunityCare System documentation and State prescribed timeframes
• Serves as member advocate and facilitator to resolve issues that may be perceived as barriers to care
• Provides education and coordination of community resource referrals to members and providers
• Develops, implements, maintains and evaluates 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
• Collaborates and communicates 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
• Maintains monitoring of hospital encounters of assigned members and provides education and/or interventions as necessary to reduce frequency
• Refers clinical decisions beyond level of authority for members who do not meet established criteria to manager and/or Team Leader for review and decision
• Participates in the Health Plan Quality Improvement process including recognition of quality-of-care issues and forward information to appropriate staff for review and resolution
• Utilizes Health Plan software to enter service requests, document, and monitor all aspects of patient care coordination and service delivery
• Coordinates services for members following Health plan policy
• Performs other duties as assigned

Required 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
• CCM 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