Licensed Field Care Coordinator - Davidson, Wilson, & Sumner Counties TN

UnitedHealth Group•Brentwood, TN

12d•$29 - $52•Hybrid

About The Position

The Licensed 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 help ensure appropriate access to services and providers. Care coordination spans early identification of health risks, education and prevention, and arranging appropriate services in acute, home, chronic and alternative care settings in a cost-effective manner. The role collaborates with Case Management, Utilization Review and Behavioral Health team members. This is a field-based role for someone located in or within commutable driving distance of Davidson, Wilson and Sumner Counties, Tennessee. The position offers remote work flexibility alongside travel within the assigned territory to meet with members and providers. Telecommuters must follow UnitedHealth Group’s Telecommuter Policy.

Requirements

Current Registered Nurse (RN) license.
At least 2 years of clinical experience as an RN.
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 Monroe County, as stated in the posting.
Reliable transportation and a valid U.S. driver's license, with ability to travel up to 75% within an assigned territory to meet with members and providers.
Adhere to UnitedHealth Group’s Telecommuter Policy if telecommuting.
Pass a drug test before beginning employment.

Nice To Haves

BSN 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 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 individual, member-centered care plans when indicated, 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 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 coordinator’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 to appropriate staff 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 member services in accordance with health plan policy.
Perform other duties as assigned.