Field Care Coordinator - Sevier & Knox County
About The Position
At UnitedHealthcare, 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 coordinator works directly with members to help ensure appropriate access to services and providers. Care coordination across the continuum includes early identification of health risks, education, and prevention, using the six essential activities of case management as described by CMSA. The role coordinates appropriate services across acute, home, chronic, and alternative care settings in the most cost-effective manner available, and collaborates with Case Management, Utilization Review, and Behavioral Health team members. This is a field-based, remote-eligible role for candidates located in or within commutable driving distance of Sevier and Knox Counties. The coordinator conducts member assessments by phone and face to face, develops and monitors individualized care plans, connects members with community resources, and documents and coordinates services in accordance with Health Plan policies, procedures, and regulatory requirements. The position may require travel of up to 75% within the assigned territory.
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.
- Excellent organization, communication, and time-management skills.
- Ability to travel up to 75% within an assigned territory to meet with members and providers.
- Reside in or within a commutable driving distance of Sevier County.
- Access to reliable transportation and a valid U.S. driver’s license.
- Adhere to UnitedHealth Group’s Telecommuter Policy if working remotely.
- Pass a drug test before beginning employment.
Nice To Haves
- LCSW or LBSW.
- Master’s degree 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.
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.
- Deliver member-centered, individualized self-management support and patient education.
- Ensure appropriate utilization and consistent application of health benefits.
- Conduct telephonic and face-to-face assessments according to Health Plan policy and procedure, including system documentation and State-prescribed timeframes.
- Advocate for members and facilitate resolution of issues that may be barriers to care.
- Educate members and providers and coordinate community resource referrals.
- Develop, implement, maintain, and evaluate member-centered individual care plans when indicated, based on identified care needs and proactive collaboration with members, families, and providers.
- Collaborate and communicate with Care Coordination Team members to improve the quality and efficiency of health care delivery and support smooth transitions of care coordination activities.
- Monitor hospital encounters of assigned members and provide education or interventions as necessary to reduce their frequency.
- Refer clinical decisions beyond the position's level of authority to a manager for review and decision.
- Participate in the Health Plan Quality Improvement process, recognize 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 ensure compliance with regulatory agencies.
- Coordinate services for members in accordance with Health Plan policy.
- Perform other duties as assigned.
Benefits
- Comprehensive benefits package, subject to eligibility requirements.
- Incentive and recognition programs.
- Equity stock purchase.
- 401(k) contribution, subject to eligibility requirements.
- Development opportunities for other roles.
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What This Job Offers
Job Type
Full-time
