Field Care Coordinator - Blount County

UnitedHealth Group•Maryville, TN

10d•$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 coordinator works directly with members to help ensure appropriate access to services and providers, and coordinates care across the continuum through early identification of health risks, education, and prevention. The role helps arrange appropriate services in acute, home, chronic, and alternative care settings in the most cost-effective manner available, collaborating with Case Management, Utilization Review, and Behavioral Health colleagues. This is a field-based role for someone located in or within commuting distance of the assigned territory, with flexibility to work remotely. The coordinator conducts telephonic and face-to-face assessments, develops and monitors individualized care plans, supports members in navigating care and community resources, and maintains timely documentation in accordance with health plan policy 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 to Sevier County.
Access to reliable transportation and a valid U.S. driver’s license.
Telecommuters must adhere to UnitedHealth Group’s Telecommuter Policy.
Candidates must pass a drug test before beginning employment.

Nice To Haves

LCSW, LBSW, or a 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.
Help 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 about community resources and coordinate referrals.
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 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 role's authority to a manager for review and decision when members do not meet established criteria.
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 support compliance with regulatory agencies.
Coordinate services for members in accordance with health plan policy.
Perform other duties as assigned.