Field Care Coordinator RN, Licensed Social Worker or LPN in Greene or Cocke County TN Position Available In Sullivan, Tennessee

Field Care Coordinator RN, Licensed Social Worker or LPN in Greene or Cocke County TN

Requisition Number:

2284643

Job Category:

Medical & Clinical Operations

Primary Location:

Kingsport, TN, US At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The primary purpose of this position is the application of clinical knowledge to coordinate member care needs for assigned members who are primarily medically complex and require intensive medical and psychosocial support. The Care Coordinator works directly with members to ensure appropriate access to services and providers. Coordination of member care needs across the continuum begins with early identification of health risk factors, education, and prevention using the six essential activities of case management as per CMSA. Coordination also assures the provision of appropriate services in acute, home, chronic and alternative care settings, to meet member needs in the most cost-effective manner available. Collaborates with all members of the Care Coordination team including Case Management, Utilization Review and Behavioral Health team members.

Primary Responsibilities:

Application of clinical knowledge to effect efficient case management for those accessing their Medicare/Medicaid benefits
Incorporates evidence-based clinical practices into care coordination activities
Delivers member-centered, individualized self-management support and patient education
Installs appropriate equipment or supplies as needed and educates member on safe and effective use
Facilitates and participates in group visit strategies as defined by site, member and/or provider needs
Ensure appropriate utilization and consistent application of the health benefits
Conduct telephonic and face to face assessments according to Health Plan policy and procedure, including CareOne/System documentation and State prescribed timeframes
Serve as member advocate and facilitator to resolve issues that may be perceived as barriers to care
Provide education and coordination of community resource referrals to members and providers
Develop, implement, maintain and evaluate a member centered, individual care plan when services are indicated, based on member care needs identified through proactive collaboration and communication with members, families and providers
Collaborate and communicate with other members of the Care Coordination Team to improve the quality and efficiency of health care delivery and assure smooth transition of care coordination activities to other team members
Coordinates care with AmeriChoice Inpatient Care Manager when member becomes hospitalized or seeks Emergency Room Services
Monitor hospital encounters of assigned members and provide education and/or interventions as necessary to reduce frequency
Refer clinical decisions beyond level of authority for members who do not meet established criteria to manager and/or Team Leader for review and decision
Participate in the Health Plan Quality Improvement process including recognition of quality-of-care issues and forward information to appropriate staff for review and resolution
Utilize Health Plan software to enter service requests, document, and monitor all aspects of patient care coordination and service delivery
Maintain time sensitive documentation to assure compliance with regulatory agencies
Coordinate services for members following Health plan policy
Perform other duties as assigned You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

Current nursing license (RN) OR Licensed Social Worker OR LPN
2+ years of clinical experience
1+ years of experience with MS Office, including Word, Excel, and Outlook
Proven excellent organization, communication and time management skills
Reliable transportation and the ability to travel within assigned territory to meet with members and providers

Preferred Qualifications:

BSN, Master’s Degree or Higher in Clinical Field
CCM certification
1+ years of community case management experience coordinating care for individuals with complex needs
Experience working in team-based care
Working knowledge of Medicare/Medicaid regulations
Working knowledge of medical terminology
Long term care experience The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere:

UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment. Additional Job Detail Information Requisition Number
2284643 Business Segment
UnitedHealthcare Employee Status
Regular Job Level
Individual Contributor Travel
Yes, 25 % of the

Time Country:

US Overtime Status
Non-exempt Schedule
Full-time Shift
Day Job Telecommuter Position
No