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

UnitedHealth Group•Cleveland, TN

2d•$29 - $52•Hybrid

About The Position

The Field Care Coordinator applies clinical knowledge to coordinate care for assigned members, primarily those with medically complex needs who require intensive medical and psychosocial support. The coordinator works directly with members to support appropriate access to services and providers. Care coordination spans early identification of health risks, education and prevention, and coordination of appropriate services across acute, home, chronic, and alternative care settings in a cost-effective manner. The role collaborates with Case Management, Utilization Review, Behavioral Health, and other Care Coordination team members. This is a field-based role for someone residing in or within commutable driving distance of Hamilton, Bradley, and McMinn Counties, Tennessee. The role offers remote work with travel to meet members and providers. The coordinator conducts assessments, advocates for members, supports individualized care planning, monitors care and service delivery, and maintains timely documentation in accordance with health plan policies and regulatory requirements.

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.
Reside in or within commutable driving distance of Hamilton, Bradley, and McMinn Counties, Tennessee.
Reliable transportation and a valid U.S. driver’s license, with ability to travel up to 75% within an assigned territory to meet members and providers.
Telecommuters must adhere to UnitedHealth Group’s Telecommuter Policy.
Must pass a drug test before beginning employment.

Nice To Haves

LCSW or LBSW credential, 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.
Provide 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 in accordance with health plan policies, procedures, system documentation requirements, and state-prescribed timeframes.
Advocate for members and facilitate resolution of issues that may be barriers to care.
Educate members and providers about, 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 Care Coordination team members 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 necessary to reduce their frequency.
Refer clinical decisions outside the coordinator’s authority to a manager for review and decision when members do not meet established criteria.
Participate in the Health Plan Quality Improvement process, identify quality-of-care issues, and forward information for review and resolution.
Use Health Plan software to enter service requests and documents and monitor member care coordination and service delivery.
Maintain time-sensitive documentation to support regulatory compliance.
Coordinate member services in accordance with health plan policy.
Perform other duties as assigned.