Field Care Coordinator - Rutherford County, TN

UnitedHealth Group•Murfreesboro, TN

2d•$29 - $52•Remote

About The Position

The Field Care Coordinator applies clinical knowledge to coordinate care for assigned members who are primarily medically complex and need intensive medical and psychosocial support. The coordinator works directly with members to facilitate 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 role collaborates with Case Management, Utilization Review, Behavioral Health, and other Care Coordination team members. This is a field-based remote role for candidates located in or within commutable driving distance of Rutherford County, Tennessee. The coordinator conducts telephonic and face-to-face assessments, develops and monitors individualized care plans, helps members address barriers to care, coordinates community resources, and documents and monitors service delivery using Health Plan software. The role also supports care transitions, hospital-encounter monitoring, quality improvement, and compliance with applicable policies, procedures, and regulatory timeframes.

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 Rutherford County, TN.
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.

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 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.
Provide education and coordinate community-resource referrals for members and providers.
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 quality and efficiency of care delivery 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 role's authority to a manager for review and decision when members do not meet established criteria.
Participate in Health Plan quality improvement, 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 comply with regulatory requirements.
Coordinate services for members in accordance with Health Plan policy.
Perform other duties as assigned.