Licensed Field Care Coordinator - Giles County, TN

UnitedHealth Group•Fayetteville, TN

3d•$29 - $52•Hybrid

About The Position

At UnitedHealthcare, the Licensed Field Care Coordinator applies clinical knowledge to coordinate care for assigned members, primarily those with complex medical needs who require intensive medical and psychosocial support. The coordinator works directly with members to help ensure appropriate access to services and providers, using early identification of health risks, education, prevention, and the six essential activities of case management as described by CMSA. The role coordinates appropriate, cost-effective services across acute, home, chronic, and alternative care settings and collaborates with Case Management, Utilization Review, and Behavioral Health colleagues. This is a field-based role for someone located in or within commutable driving distance of Giles County and surrounding counties. The position offers remote-work flexibility alongside travel to meet 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 using Microsoft Office, including Word, Excel, and Outlook.
Excellent organization, communication, and time-management skills.
Reside in or within commutable driving distance of Giles County, Tennessee.
Reliable transportation and a valid U.S. driver’s license.
Ability to travel up to 75% within an assigned territory to meet with members and providers.

Nice To Haves

Bachelor of Science in Nursing (BSN) or a master’s degree in a clinical field.
Certified Case Manager (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 people accessing Medicare and Medicaid benefits.
Incorporate evidence-based clinical practices into care coordination activities.
Deliver member-centered, individualized self-management support and patient education.
Ensure appropriate utilization and consistent application of health benefits.
Conduct telephone and face-to-face assessments according to Health Plan policies and procedures, 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 individualized, member-centered care plans when indicated, based on identified care needs and proactive collaboration with members, families, and providers.
Collaborate and communicate with Care Coordination Team members to improve the 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 role’s authority, including cases that do not meet established criteria, to a manager for review and decision.
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.