HSS Clinical Coordinator RN -Knox County

UnitedHealth Group•Knoxville, TN

5h•$29 - $52•Remote

About The Position

The HSS Clinical Coordinator RN applies clinical knowledge to coordinate care for assigned members, primarily those with medically complex needs who require intensive medical and psychosocial support. The role works directly with members to promote appropriate access to services and providers, identify health risks early, and support education and prevention using the six essential activities of case management as defined by CMSA. It coordinates appropriate services across acute, home, chronic, and alternative care settings in a cost-effective manner, and collaborates with Case Management, Utilization Review, and Behavioral Health team members. This is a remote, field-based position for someone located in or within commutable driving distance of Knox County, with approximately 75% travel within the assigned territory. The role includes member assessments, care planning, advocacy, education, service coordination, documentation, and collaboration to support quality and continuity of care.

Requirements

Active Registered Nurse license for Tennessee.
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 commutable driving distance of Knox County.
Access to reliable transportation and a valid U.S. driver's license.
Adherence to UnitedHealth Group's Telecommuter Policy.
Pass a drug test before beginning employment.

Nice To Haves

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 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 referrals to community resources.
Develop, implement, maintain, and evaluate individual 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 ensure smooth transitions of care 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 level of authority to a manager for review and decision.
Participate in Health Plan Quality Improvement, 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 timely documentation to ensure compliance with regulatory agencies.
Coordinate member services in accordance with Health Plan policy.
Perform other duties as assigned.