Licensed Field Care Coordinator - Rutherford County, TN

UnitedHealth Group•Murfreesboro, TN

2d•$29 - $52•Remote

About The Position

The Licensed Field Care Coordinator applies clinical knowledge to coordinate care for assigned members, primarily those with medically complex conditions who need intensive medical and psychosocial support. The coordinator works directly with members to help ensure appropriate access to services and providers, identify health risks early, provide education and prevention, and coordinate appropriate care across acute, home, chronic, and alternative 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 located in or within commutable driving distance of Rutherford County and surrounding counties, with remote-work flexibility. The position requires travel within an assigned territory to meet members and providers. The coordinator also documents and monitors care coordination and service delivery using Health Plan software, and maintains timely documentation to meet regulatory requirements.

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 a commutable driving distance of Rutherford County.
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.
Adherence to UnitedHealth Group's Telecommuter Policy.
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 promote 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 and procedures, including system documentation and State-prescribed timeframes.
Act as a member advocate and facilitator to resolve 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 needs and collaboration with members, families, and providers.
Collaborate and communicate with the Care Coordination Team 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 level of authority 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 ensure compliance with regulatory agencies.
Coordinate member services in accordance with Health Plan policy.
Perform other duties as assigned.