Licensed Field Care Coordinator - Middle TN

Licensed Field Care Coordinator – Middle TN (2365096) 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 ensures the provision of appropriate services in acute, home, chronic and alternative care settings to meet member needs in the most cost‑effective manner available. The Coordinator collaborates with all members of the Care Coordination team including Case Management, Utilization Review and Behavioral Health team members. If you are located in or within commutable driving distance to Coffee, Franklin, Van Buren, Warren or Grundy Counties, 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 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 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 Required Qualifications 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 Benefits Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $29 to $52 per hour based on full‑time employment. We comply with all minimum wage laws as applicable. *All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy. Location Primary Location: US‑TN‑Franklin Other Locations: US‑TN‑Manchester, US‑TN‑McMinnville, US‑TN‑Spencer, US‑TN‑Altamont EEO Statement UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes. UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment. #J-18808-Ljbffr UnitedHealthcare