Field Care Coordinator - Hamilton, Bradley and McMinn County, TN

UnitedHealth Group•Cleveland, TN

18d•$29 - $52•Remote

About The Position

The Field Care Coordinator applies clinical knowledge to coordinate care for assigned members, primarily those with medically complex needs requiring intensive medical and psychosocial support. The role works directly with members to support appropriate access to services and providers. Care coordination spans the continuum, from early identification of health risks, education, and prevention through coordination of appropriate services in acute, home, chronic, and alternative care settings, with attention to cost-effective care. The coordinator collaborates with Case Management, Utilization Review, Behavioral Health, and other Care Coordination team members. This is a field-based role for someone located in or within commutable driving distance of Hamilton, Bradley, and McMinn Counties, Tennessee. The position offers remote flexibility and requires travel within an assigned territory to meet with members and providers. Telecommuters must comply with UnitedHealth Group’s Telecommuter Policy.

Requirements

Bachelor’s degree in social work, nursing, or another health care profession, including LPN.
At least 2 years of clinical case management experience.
At least 1 year of experience with MS Office, including Word, Excel, and Outlook.
Reside in or within commutable driving distance of Hamilton, Bradley, and McMinn Counties, Tennessee.
Valid driver’s license, access to reliable transportation, and ability to travel up to 75% within an assigned territory to meet with members and providers.

Nice To Haves

LCSW, LBSW, or a master’s degree or higher in a clinical field.
CCM certification.
At least 1 year 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 and Medicaid regulations.
Working knowledge of medical terminology.
Excellent organization, communication, and time management skills.

Responsibilities

Apply clinical knowledge to support efficient case management for members accessing Medicare and Medicaid benefits.
Incorporate evidence-based clinical practices into care coordination activities.
Provide member-centered, individualized self-management support and patient education.
Promote appropriate utilization and consistent application of health benefits.
Conduct telephonic and face-to-face assessments according to Health Plan policies and procedures, including system documentation and state-prescribed timeframes.
Act as a member advocate and facilitator to resolve perceived barriers to care.
Educate members and providers and coordinate referrals to community resources.
Develop, implement, maintain, and evaluate individualized, member-centered care plans based on identified needs and collaboration with members, families, and providers.
Collaborate and communicate with the Care Coordination Team to improve care delivery quality and efficiency and support smooth transitions of coordination activities.
Monitor hospital encounters of assigned members and provide education or interventions as needed to reduce their frequency.
Refer clinical decisions beyond the role’s authority to a manager for review and decision.
Participate in Health Plan Quality Improvement activities, identify quality-of-care issues, and forward information for review and resolution.
Use Health Plan software to enter service requests and document and monitor member care coordination and service delivery.
Maintain time-sensitive documentation to support regulatory compliance.
Coordinate services for members in accordance with Health Plan policy.
Perform other duties as assigned.