HSS Clinical Quality Coordinator - Telephonic in Texas

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This function is for UHC C & S. Positions in this function address efforts focused on medical, behavioral, and social determinants of health that improve the well-being of individuals, families, and communities. As an HSS Clinical Quality Coordinator, you will be responsible for, coordinating care for members transitioning from an inpatient hospital setting to home or another level of care. The role focuses on developing individualized plans of care, identifying barriers to successful recovery, and reducing potentially preventable hospital readmissions through proactive assessment, education, and care coordination. This is a fast-paced working environment that requires the ability to multitask with attention to detail and excellent organizational skills.

If you reside within the state of Texas, you will enjoy the flexibility to telecommute* as you take on some tough challenges.

Primary Responsibilities

• Conduct post-discharge outreach and interventions to reduce potentially preventable readmissions while meeting contractual obligations per state regulatory requirement
• Assess, plan and implement care strategies that are individualized by member and directed toward the most appropriate, lease restrictive level of care
• Discuss discharge planning to ensure understanding and assist in ensuring all ordered services are arranged prior to discharge Assist members with obtaining necessary HCBS support and services
• Coordinate with physicians, hospital case managers, discharge planners, caregivers and community resources to ensure continuity of care
• Utilize both company and community-based resources to establish a safe and effective case management plan for members while leveraging evidence-based guidelines
• Collaborate with member, family, and healthcare providers to develop an individualized plan of care
• Work with members to identify potential barriers to achieving healthcare goals and outcomes
• Identify and initiate referrals for specialized case management programs, social service programs, including financial, psychosocial, community, and state supportive services
• Resolve barriers to in-home care, transportation, medical or medications and find alternatives for additional support if needed
• Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members
• Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the healthcare team
• Document all member assessments, care plan and referrals provided
• Participate in Interdisciplinary team meetings/rounds and provide information to support members individualized needs
• Understand insurance products, benefits, coverage limitations, and governmental regulations as it applies to the health plan
• Understand role and how it affects utilization and quality outcomes including reducing potentially preventable events
• Provide, arrange, and coordinate preventive, primary, acute care, behavioral health and pharmacy services that contribute to the well-being of the member
• Review medical records for compliance with regulatory guidelines (e.g., NCQA, state Medicaid contracts, and compliance)
• Work with internal partners to create a culture of health and wellness that promotes member health
• Provide individualized education on preventative healthcare measures (e.g., immunization, healthcare screening) to close quality gaps in care

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

• Active LVN license in the state of Texas
• 2+ years of experience working with electronic health records
• 2+ years of experience working with Medicaid/Medicare members with complex medical or behavioral needs
• Intermediate level of proficiency with MS Office applications

Preferred Qualifications

• 2+ years' experience diversified clinical nursing experience, including medical/surgical, case management or discharge planning
• Knowledge of quality metrics, pay for quality or HEIDIS measures
• Demonstrated ability to assist with achieving targets, including productivity and certain metrics
• Previous experience working in a telecommute role

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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 benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $24.00 to $43.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

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