At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

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.

If you are located in Hamilton County, TN or surrounding areas, you’ll enjoy the flexibility to work remotely * as you take on some tough challenges. This is a field-based role.

Primary Responsibilities:

• Application of clinical knowledge to effect efficient case management for those accessing their Medicare/Medicaid benefits
• 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 CareOne/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 AmeriChoice Inpatient Care Manager when member becomes hospitalized or seeks Emergency Room Services
• Monitor hospital encounters of assigned members and provide education and/or interventions as necessary to reduce frequency
• Refer clinical decisions beyond level of authority for members who do not meet established criteria to manager and/or Team Leader for review and decision
• Participate in the Health Plan Quality Improvement process including recognition of quality-of-care issues and forward information to appropriate staff for review and resolution
• Utilize Health Plan software to enter service requests, document, and monitor all aspects of patient care coordination and service delivery
• Maintain time sensitive documentation to assure compliance with regulatory agencies
• Coordinate services for members following Health plan policy
• Perform 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:

• Current nursing license (RN) OR Licensed Social Worker
• 2+ years of clinical experience
• 1+ years of experience with MS Office, including Word, Excel, and Outlook
• Excellent organization, communication and time management skills
• Reliable transportation and the ability to travel within assigned territory to meet with members and providers

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
• Working knowledge of Medicare/Medicaid regulations
• Working knowledge of medical terminology
• Long term care experience
• Experience working in team-based care

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.